Your doctor has recommended a procedure, Robot
Assisted Laparoscopic Radical Prostatectomy
to treat your prostate cancer.
Before we talk about the procedure, let’s
review some information about the prostate
and your medical condition.
The prostate is located under the bladder
and behind the penis.
It is a walnut-sized gland that is part of
the male reproductive system.
It helps make semen.
The Urethra is a tube that carries both urine
and semen to the penis.
It passes through the prostate which surrounds
it like a donut.
Prostate cancer is the second most common
cancer in men.
It usually occurs in men age 50 and older
and those men that have a family history,
especially a father or brother with prostate
cancer.
But the highest risk is for men that are African
American and over age 70
The treatment of your cancer will depend on
many factors including the size, spread and
type of cancer, your age and health.
The options that you may have considered are
watch and wait, medication including hormones,
radiation therapy and/or surgery.
It is very important that you understand why
this surgery has been recommended for you.
If you have questions, ask.
Radical Prostatectomy is surgery to remove
the whole prostate gland, some nearby tissue
and lymph nodes.
Everything removed is tested to be sure
the cancer has not spread.
This surgery is only used as a treatment if
the prostate cancer is still in the prostate.
If the cancer has already spread, then surgery
does not help and can cause serious problems
when other treatments are used.
In fact, if during surgery, the surgeon finds
that the cancer has already spread and is
outside of the prostate, the procedure is
stopped and other more effective treatments
for the situation are planned.
There are different ways to operate and remove
a cancerous prostate.
Your surgeon has recommended a laparoscopic
procedure.
A long instrument with a light and camera,
called a laparoscope is used.
The scope makes it possible for your surgeon
to see and operate on hard to reach, delicate
tissue.
This is minimally invasive surgery that uses
very small incisions instead of a classic
large incision.
Healing and return to normal activity is
usually faster with less bleeding and fewer
complications.
With all laparoscopic procedures, the surgical
team is prepared to change your surgery to
an open procedure with a larger incision if
this becomes necessary.
An open procedure is sometimes needed to
treat unexpected bleeding or other findings
during a procedure that make it impossible
to do using a laparoscope.
If this happens your stay in the hospital
and recovery will be longer than you originally
expected.
Your surgeon has scheduled your laparoscopic
procedure to be Robot Assisted.
This means that your surgical team will work
with pieces of equipment that together are
called the robot.
The tower has a video screen for the team
and surgeon to see the surgery in high definition.
The surgeon sits at a console that makes it
easier to see drive and move special tools
to do delicate cutting and stitching.
The robot has arms that attach to the laparoscope
and other tools as needed.
Now let’s talk a little more about what
happens during a Robot Assisted Laparoscopic
Radical Prostatectomy.
General anesthesia and medications to make
you asleep and pain-free during your procedure
are given.
A tiny incision is made and your abdomen is
filled with CO2 (say “C” “Oh” “2”),
carbon dioxide gas.
Other small  incisions are made as needed
for the surgeon to place tools that are used
to cut, stitch, move and remove tissue for
the procedure.
The robot is carefully connected to the laparoscopic
instruments.
The bladder is gently separated from the prostate,
The connection of the prostate to the bladder
is cut.
And then the connection to the urethra,
The surgeon is careful to protect the nerves
that  control your erection and urination.
However, Damage to the nerves may be necessary
or unavoidable in removing your prostate.
The Prostate is carefully placed in a bag,
and removed thru a small incision.
This way no cancer cells are spread.
Finally the bladder is stitched back to the
urethra
The surgical area is carefully inspected for
bleeding and a surgical drain is placed.
The instruments and gas are removed.
The incisions are closed.
After surgery, “speak-up” and tell someone
on your care-team if you have unexpected pain,
dizziness or trouble breathing.
You will have some discomfort but medication
should help if you have pain.
Your risk of complication from this surgery
is most related to your health before surgery,
the size and nature of your cancer and the
experience of your surgeon.
Prostate cancer typically affects older men
with other medical problems.
Your team will watch for early rare complications
such as stroke, heart attack, blood clot,
and internal bleeding.
Most patients stay in the hospital for 1-3
nights after surgery.
The drain is often removed before you are
sent home.
The Foley will stay in place for about 1 to
3 weeks.Incontinence, leaking urine is a known
side effect of prostatectomy.
It is normal to have after your Foley is
removed.
You will need to wear a pad to stay dry.
Control of urine improves quickly over the
following days, weeks and months.
By 6 months, 20% or 1 in 5 men still have
some urine leakage and 5% or 5 in 100 men
have severe leakage.
Another side effect of this surgery is erectile
dysfunction or ED.
All men will have trouble with their erections
after prostate removal.
Half of men, 50% will eventually be able
to have an erection but most will continue
to have some permanent changes.
Time, exercise, medication and surgery can
help.
Call your doctor if you: cannot urinate, have
a fever, redness or pus from your incision,
worsening pain or bright red bleeding that
doesn’t stop
Be patient as you heal.
Communicate your concerns with your surgeon.
If you do have long term side effects from
your procedure, you can see improvement with
time, further healing, medication, exercise
or more surgery.
To avoid cancellation or complications from
anesthesia or your procedure, your Job as
the Patient is to-
·    Not eat or drink anything after midnight,
the night before surgery, not even a stick
of gum
·       Take only medications you were
told to on the morning of surgery with a sip
of water
·       Ask when to stop your aspirin
or blood thinners before surgery
·       Arrive on time
You should be ready to verify or confirm your:
• list of medical problems and surgeries,
• All of your  medications, including vitamins
and supplements
• current smoking, alcohol and drug use
• and
• All allergies, especially to medications,
latex and tape
but not all surgeons find using the robot
helpful in performing laparoscopic surgery.
Not all hospitals have this equipment.
The robot adds about 30 minutes to your procedure
for set-up, it is more expensive and there
have been rare but serious complications related
to its use.
Your surgeon has recommended the robot for
your situation and believes it may help there
to be less bleeding, nerve damage, incontinence
and/or erectile dysfunction.
All surgery and anesthesia have a small but
possible risk of serious injury, even some
problems very rarely leading to death.
It is your job to speak up and ask your surgeon
if you still have questions about why this
surgery is being recommended for you, the
risks and alternatives.
This video is intended as a tool to help you
to better understand the procedure that you
are scheduled to have or are considering.
It is not intended to replace any discussion,
decision making or advice of your surgeon.
