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What does robotic prostatectomy look like? Is it like a vasectomy?
This week I watched a video of a complete robotic prostatectomy procedure in Italy. It was on a medical education site for doctors. What a long drawn out complicated procedure! It took one hour 46 minutes of continuous resection, not including initial setup. They used 6 ports and had tiny scissors in the right hand that could also cauterize by passing high frequency AC current through them, with a grounding pad attached to the patient's skin. Tiny sparks and smoke can be seen. This is the same as the Bovie scalpel they have used to minimize bleeding during surgery since 1926. They also used a small clamp in the left hand, and it could be used for bipolar cauterization where current is passed from one half of the clamp, through to the other half of the clamp. Larger vessels were clamped with plastic clips.
With these devised blood loss was fairly minimal but suction was used to keep the surgical field clear and the surgeon had a pretty good view. The degree of magnification could be adjusted. During endoscopic surgeries they can pump in carbon dioxide gas to create an open cave to work in.
The urethra passes right through the prostate and a section about 5 to 8 cm long (1 to 1.5 inches) had to be removed with the prostate. It is amazing that they can simply sew the two ends of the urethra back together with dissolving sutures. They pass a Foley catheter through the urethra so that it can be clearly identified, and it is used to align the two parts of the urethra during suturing. The spermatic ducts also have to be cut, giving the same results as a vasectomy. Of course it is a much bigger surgery than vasectomy.
My wife is a retired embryologist and they sometimes did a wedge resection of a testicle to try to recover a few sperm in men who wanted IVF after a surgery like this, or after a vasectomy. The embryologist had to go fishing under a powerful binocular microscope, catch a sperm, cut off its tail before it could swim away, suck it into a tiny glass tube and then inject it into an ovum. Incubated it for a few days until it divided into about 8 cells before implanting it in the uterus.
They also had men provide a semen sample to freeze in liquid nitrogen before surgery so that it could be used for IVF later. You have to pay rental to keep the sample frozen.
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A friend of mine watched a video on this being done before his surgery and said he wish he hadn't watched it. I was determined not to watch it and didn't. Mine latest 3 hours and 15 minutes and is now out as of May 5th. They know what they're doing and you're asleep so it's not like you can say, "hey stop that's not right" LOL!
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3 ReactionsHa!
Totally, for me that would be like watching an atrocity video!
Definitely don't have the stomach for that...
Glad my eyes will be firmly shut when they do it on me.
I do not think an open heart surgery looks more appealing or a kidney transplant or brain tumor removal , and how about hysterectomy or breast removal ? No surgery is fun to watch for a lay person, I guess. My husband and me had no problem watching - found it fascinating and we are respecting surgeons even more now. To have such a skill is really extraordinary in every way.
God bless them all < 3
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1 ReactionWhite 5-6 port (incision) RP is still common place, the "industry" is moving to the DaVinci "single incision" Robotic-assisted Radical Prostatectomy. I had the DaVinci single-incision procedure. My urologist only does single-incision procedure. My incision (a.k.a "scar") is about 2 1/2 inches wide, and about 2 1/2" below my navel. I have no reference, of course, for the outcome of the 5-6 incision multi-port procedure, but I can tell you that the single-incision is no cakewalk. No matter the means of surgery, this is a major surgery. Thank God for Percocet...I felt assaulted, pummeled, and beat down below my navel for most of the 10 days that my catheter was in. At day #5-6, I was wondering if I'd be able to drive to my catheter removal appointment (I was able, but not super-comfortable). When my urologist told me he does the single-incision DaVinci procedure, I saw the logic: why suffer 5-6 incisions and scars, when one incision accomplishes the same thing? Having just written that makes me want to investigate a comparison of surgical outcomes of the 5-6 incision vs single-incision methods. Either way, they take your prostate, but maybe one is actually better.
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2 ReactionsResults are the same and pain is the same and pain level is very individual as it is with any surgery. There are people with minimal discomfort and people that need strong pain medication after this or any other medical procedure. There are people that need Percocet after tooth extrication, and people that did not need anything but Tylenol and Ibuprofen after RARP for the first 3 days. It is all very individual and does not necessarily relates to a technique used.
Also, if RP is pretty straightforward it will cause less bleeding and trauma to the pelvic area in comparison to RP that involves big prostate, cancer that spread outside of the gland margins and/or involves lymph-node removal, etc.
Pain level will also be more pronounced in older patients, or patients that in general are not very fit or are overweight.
My husband's surgeon performs both kinds to RARP but we opted for multi-port since that technique offers better maneuverability, especially for posterior location of a tumor.
All in all, no surgery is "minor" and every kind of surgery can be "major" depending of any particular case and of a patient and also of surgeon's skill.
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4 ReactionsAlive - good comments here . A RP is major surgery . It has improved so much over time . Uro's really know what they are doing . It is perfect ? No! But its a very good method of PC cure and/or control . Usually a small blast of External Beam Radiation Therapy ( EBRT) is requested to clean up some arrant cells in Pelvic region. Now , som of these cells could be PC and some may be perfectly normal Prostate cells too ! Your under ( or should be ! ) deep anaesthetic( ask Dr to ensure deep sleep and no pain when waking up etc ... ) . This should work out fine if you select this method . Best this about this method is having the Prostate out and FULL Biopsy on gland ! They find all sorts of things . Down side is longer recovery time than most forms of Radiation. We are here for you mate ! Keep us in the loop . James on Vancouver Island .
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1 ReactionThanks to Vancouver and others. I had my robotic prostatectomy in the relatively early years - 2010 and it required multiple ports. I have had 6 surgeries in this area, once for prostatectomy, then the first AMS 800 artificial urinary sphincter. It had a 3.5cm long cuff around the urethra. The pump failed to work so I went back for revision. Gradually it stopped working and I had a second one put in (5.5cm long). After several years a pipe migrated through the skin and it all had to be removed. 3 weeks ago I had the third one put in. This time they could only fit a 4cm cuff directly under the bladder, and I have a feeling that might work better. It will be turned on after 6 weeks recovery. I have never had to take more than one oxycodone tablet after each surgery, so I am one of the lucky ones!
In 2 weeks we will celebrate our 54th wedding anniversary. For or 45th anniversary we spent 3 weeks going to Vancouver Island from Tennessee. We did 1000 miles in 3 days going and another 1000 miles in 3 days coming back. But the 2 weeks in Canada and Vancouver Island was absolutely fantastic. The highlight, on the day of our anniversary, was a small wildlife boat trip from Uclulet. I ended up with a lot of great photos. My niece and nephew were born in Edmonton area but grew up in New Zealand, so I sent them a bound book of photos each.
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2 ReactionsDo you have a link to the video or site?
Never mind, I found a series of YouTube videos of at procedure in Australia that covered the procedure adequately: https://www.youtube.com/@TheProstateClinicTPC
Here is the (fairly) quick and dirty comparison:
DaVinci Robotic Assisted RP is a "single incision" procedure. The incision ("my incision") is about 2" wide and about 3 inches below my navel. Numerous tentacle-like implements are all placed through that one incision. The assumption I guess is that "one" 2-inch incision, is better than five or six 1/2 - 3/4" incisions with the 5-port, 5-incision traditional method. In retrospect, I can't imagine how "one" surgeon can handle 5-6 six separate implements in the 5-6 separate incisions??? The DaVinci single-incision method sounds easier.
One thing they don't tell you. is that to aid in the movement/manipulation of those tentacle-like implements during surgery, they inject "gas" into your belly to raise it up taut. The morning after, I complained to my nurse: "why are my shoulders so sore?", to which she replied: "Oh...that is residual gas from the gas that the surgeon injected into your abdomen. "What???" She knew that she was the first person to tell me that that is part of the procedure. The Urologist, the Anesthesiologist, nor the pre-op Holding area nurse said anything about injecting gas in my belly. That very uncomfortable shoulder pain lasted 2-3 days until it was finally gone. I was given Percocet for the surgically invasive pain since I am allergic to Vicodin, so...the Percocet did not even handle that shoulder pain from the gas well enough.
And speaking of Percocet or any narcotic pain reliever...if given to you...you will have to grapple with the constipation. When I finally felt that I needed to use the bathroom, the Percocet-induced constipation was a frustrating conundrum: I could not bear-down to defecate because of the post-op trauma and pain. That was quite an ordeal until I no longer needed the Percocet. It took 3-4 days before I felt like I could "successfully" defecate without too much strain.
Recovery time until you "can" and "want" to go out in the world is timed well with when you will return to the doctor to have your catheter removed - about 10-12 days. My experience was that I felt assaulted and pummeled down there. I had a constant awareness of "how deep" the pain was. My "incision" was a 3-4 out-of-10 on the pain scale, but the general feeling of having been assaulted down there...DEEP inside my body...was a 15-out-of-10...completely unexpected. You wouldn't think that removing something the size of a walnut could be so traumatic, but then if it was a tumor of the same size (which it essentially is), anyone would say: "that's a major surgery"...as was said per my doctor in response to my complaints of "you should have told me it would be this painful." My Urologist had previously kind of "disarmed" me a bit with his near-joyful excitement, talking-up the virtues of the DaVinci Robotic instrument method. He made it sound like a "piece of cake"... nope. Surgeons are like that...they're like mechanical guys working on the engine of their car, only the "car" is "you." I thought "easy-peasy"...NOPE.