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Newer surgery technique
In reply to someone’s post I wrote about this new surgical procedure but realize if it is not a stand alone post, many may not have seen it unless they decided to read that person’s post and comment’s which can fade fast. This post is not to try and dissuade anyone from the treatment they are leaning towards, it is just to make sure that any surgery leaning members evaluate and know surgery options.
Most patients , myself included believed all robotic laparoscopic prostatectomies were the same procedure. They are NOT! A key factor in choosing your Surgeon during consultation’s, if going with Surgery is to be aware that technologies and techniques are advancing in the field. The most up to date and advanced robotic surgery is done with the DaVinci single port robot. If your surgeon is not using the latest DaVinci Robotic model it does not change his ability in performing an outstanding surgery, but it can affect a quicker recovery, and not have the ability for state of the art surgical techniques that can alleviate the severity of possible side effects by using the newer robot.
The newer DaVinci Robotic single port (latest) makes one small incision for entry as opposed to the older widely used DaVinci model making as many as 6 small incision entries. The single port barely leaves a scar and you can leave the hospital the same day as your surgery. My surgery was in the morning 7:30am and discharged around 5:30pm. I am now 18 months post surgery and the single tiny scar is almost unnoticeable.
Nerve sparing is very important but even more important today is the newer Retzius sparing surgical technique which generally gives immediate continence upon the catheter removal and improves ED.
In the newer surgical technique the surgeon leaves intact and does not cut the puboprostatic ligament holding the bladder in place and this maintains urethral length upon reattachment to the bladder which substantially improves the likelihood of minimal post leaking if none at all. This is very important and most surgeons are not trained in this latest technique. It is called Retzius sparing. The part of the surgery in which the surgeon reattaches your urethra to your bladder is a significant part of the completion of the prostatectomy surgery. In this Retzius sparing technique the surgeon accesses the bladder from behind allowing the ligament not to be cut. You are positioned differently than in a normal robotic prostatectomy because of coming in reverse. Most patients after a prostatectomy comment on the loss of penile length. This is typically caused by the need to cinch up and reattach the urethra to a bladder that had its Puboprostatic Ligament cut and not where it was. Almost all Surgeons cut this ligament to do surgery because it is how they need to access the prostate from the normal prostatectomy surgery, however the new surgery procedure, not really new, it has been around a number of years now having come from Europe is that they go in to remove the prostate doing surgery from coming in behind the bladder, to gain access to the prostate and do not need to cut the ligament . Not only as previously reported that you do not lose penile length as the reattachment is right back to the place where the stable bladder is still positioned and the urethra was cut from, but it seems according to most literature on this, most patient’s have almost immediate continence. These certainly are the two major concerns of patients I hear about regarding surgery. The third concern is the sexual function more involved with nerve sparing and alot of that involves a surgeon’s skill around the nerve bundles. Even if the cancer has seemed to leave the capsule, a surgeon can spend extra time delicately getting to a negative margin and as in my case , nerves spared one side, half the other and 18 months post surgery, early 70’s, I am good to go fully erect penetration in the morning on an empty stomach after 4 pills sildenifil (20mg a piece) total 80mg and waiting 75 minutes. Many patients don’t realize or even know of this new surgical approach, I did not. This really shows how important it is to research your surgeon and see what robotic laparoscopic prostatectomy surgery he performs. You really have to look for this specific surgeon and consult with or call around the major hospitals to see if they have surgeons doing this technique. This still by far is not the common surgery technique but is gaining substantially more traction each year as newer surgeons who are staying up to date on the latest technology and techniques are performing it. It will likely become the standard over time due to the success in reducing side effects especially of incontinence, ed and penile length. Many major hospitals still don’t have a surgeon trained this way, it’s just finding that Surgeon and not just relying on the surgeon referral you are given by your urologist after your cancer diagnosis.
Also another very important factor in surgeon consideration is whether during surgery while you are on the table he will send the sliced prostate bed tissue and lymph nodes immediately to Pathology for inking and staining to rule out whether the cancer has left the capsule, even if the PET says it had not entered the bed or lymph nodes and is localized to the capsule. Then if pathology reports positive margin in the bed the Surgeon can go back in deeper while your are on the table to try to eliminate the positive margin. This happened in my case adding an additional two hours to my surgery with the initial positive margin coming back. Even my surgeon was surprised from his visual of inside me and the of hundreds of surgeries he has seen, and said on occasion he gets surprised. That is even though the PET suggested everything was contained. Most surgeons don’t do this and accept that the PET says it is contained and the surgeon cuts the normal surgical margins and removes some nodes and closes you up. Then at your post surgical appointment you may be told, sorry there was positive margin. Well it’s a little late I would say to hear that. In mine at that post appointment I was told final pathology with negative margin had been achieved. This additional step can really mess up a surgeon’s operating schedule, not only the time waiting for Pathology but additional time back in surgery if necessary. On their surgical day surgeons often have a morning and afternoon procedure scheduled if they need to go back in unexpectedly for several hours that was not planned, it substantially delays the afternoon procedure and for the day adds that much extra time to the Surgeon’s day. This is a major reason they don’t even if they have pathology available. For this to be done the surgery needs to be performed at a major hospital that has Pathology inhouse.
I hope this is informative for many.
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@wheel1
Our doctor did not say that it is "so much better", he just said that HE personalty finds it more useful since he can reach more places in pelvic area in a better angle - he personally prefers it even though he knows to use both. He is one of the best surgeons that there are in the USA and he was a founder of the whole prostate care center in a major CA hospital, so I do not questions his opinion or expertise. : )
My husband had VERY fast recovery in every aspect, zero pain, zero discomfort, was able to sit up, get up from bed next day without any problems or pain, and had full continence at 4 mos post op without PT classes. He was working full time after 2 weeks and 2 startups on a side, so yes - he was and is very happy with results.
Also, care in German hospitals is world class, it can not even be compared, but that is another story. 😉
The United States has the highest number of hospital-associated infections among high-income nations. Still, it was very beneficial to stay one extra day and have professional care and to make sure that all is top notch back to normal before heading home. He was in beautiful room, alone , with huge plasma TV, special leg massage devices, nice view, great menu and even big seating area for me and my daughter to relax and make him company at all hours. 😎 I made friends with nurses and got a BUNCH of stuff to bring home for easier recovery - all in all, time well spent ; ).
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2 Reactions@surftohealth88
I am sorry that you seem to believe I am disparaging past procedure technique’s like your husband may have had done. I am not. That was and primarily still is the standard of care for prostate surgery, but it is changing and patients need to know. As I have repeatedly said, using a multi port robotic does not take away a surgeon’s ability to perform an outstanding procedure, but not using the latest technology and techniques can affect side effect and recovery outcomes. I understand you are satisfied and your husband that he was able to achieve continence at 4 months. That is terrific considering how long it does take others, up to a year or not at all. Your surgeon may be one of the best in the US but I just don’t accept any surgeon today saying 4 months is better than 1, 2, or 3 days. That alone on that one side effect is a game changer. Nothing is mentioned of the other major side effect ED. Through out history medical advances get better. You certainly accept what you are generally currently offered and many do not conduct other research. Someone having double or triple bypass surgery and going home the next day, is not because of insurance today, but the extraordinary advancement’s in the procedure. Someone in the past that took several days to go home does not mean that the procedure was bad in the past in any manner, as an older prostate procedure , it just means the procedure’s are getting better with medical advancements.
@surftohealth88
We’re all here to support one another and share our experiences.
You shared your story, and Wheel1 shared his. Everyone can take in the information and decide what feels right for them. I don’t think the number of ports is really the key issue—he’s simply trying to provide information based on his experience.
There are newer surgical techniques that can allow for immediate continence while also preserving nerves. In your husband’s case, it took about four months for the incontinence to resolve. In my case, it was very different—my leakage stopped completely four days after the catheter was removed—and I’d like to share that perspective as well. For me, the number of ports (single vs. multiple) isn’t what mattered most
My surgeon used an approach from behind the bladder (through the pouch of Douglas), which avoids disturbing the Retzius space. From what I understand, this can help support earlier—sometimes immediate—urinary control.
I agree with you that a lot comes down to the surgeon’s level of expertise.
@surftohealth88 No overnight stay is the ideal scenario but it may not happen.
I had multi-port and was supposed to stay one night.
However, one drain kept filling with blood and my surgeon decided that I would spend another night just to be sure I wouldn’t need to be re-admitted.
It sucked but so it goes when men make plans.
Phil
This post was under newer surgical procedures meant for the newly diagnosed who will be pursuing the surgical approach. It was not meant to disparage past treatment procedures nor to change patients with surgery imminent or just around the corner with their surgeries set.
Minimal side effects , quick recovery and no cancer. Boiled down to a nutshell is what everyone wants from surgery . Minimal side effects mean no or minimal leaking and continued sexually activity if currently active, and yes of course being cancer free is the goal of the surgery. Everyone is free to pursue those goals with the Surgeon they choose best meeting the degree to what they want. Everyone should just be aware that ports and things do matter. If the single port , Retzius sparing, anterior fascia sparing, Fascial -preserving approach and real time surgical pathology are avenues that give you opportunities that you might not have for better continence, less ED and higher degree that the cancer is gone, why not pursue those avenues or at least look into them. None of those will matter without surgical competence though. The literature and NIH studies are about reflect these advances.
I am glad this conversation got started because before it did many patients had no knowledge their was anything but a generic robotic laparoscopic radical prostatectomy. Before single, there was multiple and before multiple there was open. The literature and studies are their regarding the advantages of the new single port or their would be no new single port. Many now are aware that their are differences in robotic surgery and how those considerations might shape their surgical decision.
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3 ReactionsThank you for sharing. What is name of new procedure and the manufacturer who makes it.
@tld56
The da Vinci surgical system is manufactured by Intuitive. The surgical procedure is officially known as Retzius-sparing robot-assisted radical prostatectomy (RS-RARP). It is also referred to as a posterior approach prostatectomy.
@mozir
Yes, that is why I shared our expirenace lol
I write on this forum mostly for "others", not myself.
I want patients to know that surgeon's expertise is the most important factor and I would like to add that any individual result is just that - individual.
No matter what technique one uses or what machine, there will be cases of full continence and cases of continence that needs some recovery time and than about 5 % of cases that will have permanent incontinence .
The SAME applies for ED. There are patients who have erection the first night at hospital and than there are some that never achieve it regardless of the number of ports.
Just ask @rlpostrp - as far as I remember he had SINGLE PORT last year, he is still having complete ED and had prolonged problems with incontinence (maybe still has) , I hope that he will come here and tell you about his "single port" surgery.
Regarding our surgeon - he had patients with full continence upon catheter removal and erections the first week. My husband had 4 mos of minor dribbling and his ED is recovering nicely, thank you very much lol, I just do not like to share my intimate details here.
Recovery depends on soooo many details beside surgical technique that it is unreasonable to attribute it to number of ports. Beside of surgeon's expertise results depend of extent of cancer - if it escaped the capsule surgeon HAS to cut into nerves. If prostate is very big -surgeon HAS to cut more of an urethra. If patient is obese or out of shape, had any ED problems before surgery , had a weak pelvic floor etc etc, his recovery and results will be different no matter how many ports were used.
I am writing all of this so FUTURE patients know and have reasonable expectations and do not worry if their surgeon uses multi port - he can do Retzius sparing with multi-port too . Your SA will depend on many other factors beside surgical technique.
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