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How Is Prostate Removal Performed

What Are Some Of The Stigmas And/or Misconceptions Regarding Robotic Surgery What Drives Them

Prostate Surgery: Prostatectomy

Robotic surgery has developed leaps and bounds over the last 20 years, especially in urology. This was a very hot topic when robotic surgery started being used in urology almost two decades ago, particularly when no one even thought that this was a feasible technology for use in surgery let alone Urology. In particular, robotic surgery was used for prostate cancer surgery and then slowly evolved for use in many other areas in urology, including kidney cancer, bladder cancer and reconstructive surgery. Today most major urologic surgical procedures are being done robotically.

Again, a lot of it is experience, the comfort level of the surgeon, and what were trying to accomplish. Going back to your original questionthe stigmatheres always going to be a stigma of new technologies and new ways of doing things. I think as the surgeons and as the staff get more and more comfortable with these technologies, thats where the stigma starts to go away. And, in fact, if enough surgeons do it, then it becomes standard of care. And so, the standard of care, like I said in 2021, does call for the robotic approach with many procedures.

What Is The Prostate Gland And Why Is A Prostatectomy Performed

A prostatectomy is performed in order to treat a variety of conditions which can affect the prostate gland. This gland is the size of a walnut and is located inside the male body, beneath the bladder and between the bladder and the penis.

Women also have a gland which is equivalent to it, commonly referred to in medicine as the paraurethral gland or Skeneâs gland, but they are much less likely to be affected by problems in this area than men.

In healthy males, the prostate gland produces prostate fluid, one of the main components of semen. It also contains muscle fibres. During ejaculation, it functions to push the semen into the urethra, the duct which conveys both urine and semen out of the body.

Prostate problems most commonly develop in later life, predominantly affecting men over 50 years of age. Problems, which may be addressed by a prostatectomy, include prostate cancer, enlargement and inflammation . If you are concerned that you, or a loved one, may be experiencing problems related to the prostate, get a free symptom assessment by downloading the Ada app.

How Will Prostate Surgery Affect My Sex Life

Experienced robotic surgeons like Dr. David Samadi dont open the endopelvic fascia during surgery, which spares the rick of damage to nerve bundles that control sexual function. The recovery of the function, however, is not immediate and you should not feel discouraged if weeks or even a few months after surgery you experience erectile dysfunction. It is not an indication of long-term damage.

One major change that you will notice in your sex life is the absence of sperm. Having no prostate, the body will not produce semen during the orgasm. The sperm cells will be simply reabsorbed by the body them. This is not harmful and you shouldnt be worried about it. Plenty of men deal with the problem with the help of medication that improves erectile dysfunction.

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What To Expect After Prostate Is Removed

Following prostate removal , you can expect to be in the hospital, usually for one night for monitoring.

When patients are first sent home, activities are restricted and patients are usually advised not to drive. Over-the-counter pain medicines such as ibuprofen or acetaminophen may be used. If OTC pain relievers are inadequate, a doctor may prescribe pain medications.

About seven to 10 days after surgery, the catheter is removed, usually at the doctors office. The doctor will usually have pathology results around this time and can discuss if further treatment is needed.

Patients are advised to avoid strenuous activity or heavy lifting for at least one month after surgery, and most patients take off work for three to four weeks.

Some men experience may side effects during recovery, such as:

What Is The Difference Between Robotic And Laparoscopic Radical Prostatectomy

Radical Prostatectomy

Both are minimally-invasive techniques of performing radical prostatectomy for cancer. In laparoscopic radical prostatectomy, the surgeon stands by the operating table and himself manipulates the instruments. In robotic prostatectomy the surgeon is seated at a robotic console near the patient from where he drive the robotic instruments to perform the operation. The robot faithfully and accurately reproduces the surgeons sophisticated maneuvers.

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Risks Of Radical Prostatectomy

Radical prostatectomy has a low risk of serious complications. Death or serious disability caused by radical prostatectomy is extremely rare.

Important nerves travel through the prostate on the way to the penis. Skilled surgeons can usually protect most of these nerves during radical prostatectomy. Still, complications from inadvertent nerve damage do occur after radical prostatectomy. They include:

  • Urinary incontinence: More than 95% of men younger than age 50 are continent after radical prostatectomy. Around 85% of men aged 70 or older maintain continence after the operation.
  • Erectile dysfunction : Problems with erections are common after prostatectomy. Still, most men are able to have sex after prostatectomy while using medicines for ED , an external pump, or injectable medications. The younger the man, the higher the chance of maintaining potency after prostatectomy. A period of penile rehabilitation is often necessary.

Much of the skill involved in radical prostatectomy centers on sparing these nerves during the operation. A man undergoing radical prostatectomy by a surgeon at an advanced prostate cancer center has a better chance of maintaining sexual and urinary function.

Other complications of radical prostatectomy include:

  • Bleeding after the operation

* Minimal Blood Loss With Da Vinci Robotic

The average estimated blood loss per patient averages 116 cc. This volume is roughly the 1/3 of the volume of a 12 oz. soda can. Estimated Blood loss has ranged for robotic patients from 25cc to a maximum of 400 cc in the 1st 100 patients. Because of these low blood losses, none of these men required a blood transfusion, nor were they asked to donate autologous blood prior to surgery.

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Going Home With A Catheter

You will be discharged from the hospital with a catheter in place to drain urine from your bladder into a bag. The doctor will remove this in the office in five to 14 days. Be sure to clean the catheter where it exits your penis twice a day with soap and water and to empty the bag frequently. The bag should always be positioned lower than your bladder.

On occasion, the catheter may irritate the bladder, causing bladder spasms that can be quite uncomfortable. If these occur, your doctor can prescribe medication that can help. Leakage of urine around where the catheter exits the penis also may occur and can be managed by wearing incontinence pads as described in the next section.

It is normal for your urine to look cloudy for a few weeks after surgery. Occasionally, bleeding may occur around the catheter or be noticed within the urine. This also is common. If you see large clots â more than an inch in length â or if the catheter becomes plugged, contact your doctor. No anesthesia is required for catheter removal, and most patients experience only a little discomfort.

Types Of Prostate Surgery

Prostate Removal Surgery – TURP

There are several ways of removing the prostate keyhole surgery either by hand or robot-assisted, and open surgery.

Although robot-assisted keyhole surgery is the newest technique, the most recent research suggests all three techniques are as good as each other for treating prostate cancer, as long as the surgeon is experienced. They also have similar rates of side effects.

The advantages of keyhole surgery, both by hand and robot-assisted, are that you are likely to lose less blood, have less pain, spend less time in hospital, and heal more quickly than with open surgery.

Keyhole surgery

Keyhole surgery .

  • Robot-assisted keyhole surgery Your surgeon makes five or six small cuts in your lower abdomen and a slightly bigger cut near your belly button, and removes the prostate using special surgical tools. These include a thin, lighted tube with a small camera on the tip. The image will appear on a screen so the surgeon can see what theyre doing. Your surgeon controls the tools from a console in the operating room via four or five robotic arms. Although its called robot-assisted, its still a surgeon who does the operation. You may hear the equipment called the da Vinci® Robot.
  • Keyhole surgery by hand As with robot-assisted keyhole surgery, the surgeon will make four or five small cuts in your abdomen. But they will hold the surgical tools in their hands, rather than using robotic arms.

Open surgery

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Radical Prostatectomy Perineal Approach

  • You’ll be placed in a supine position in which the hips and knees will be fully bent with the legs spread apart and elevated with the feet resting on straps. Stirrups will be placed under your legs for support.

  • An upside-down, U-shaped incision will be made in the perineal area .

  • The doctor will try to minimize any trauma to the nerve bundles in the prostate area.

  • The prostate gland and any abnormal-looking tissue in the surrounding area will be removed.

  • The seminal vesicles may be removed if there’s concern about abnormal tissue in the vesicles.

  • What To Expect After A Robotic

    • Patients generally remain in hospital for 2-3 nights following the procedure
    • There will be some mild pain or discomfort which can be managed with medication
    • You will be encouraged to sit out of bed and walk around, as well as perform deep-breathing exercises to minimize the chance of pneumonia or blood clots in the legs or lungs
    • A urinary catheter needs to remain in place for 10-14 days following surgery to allow healing of the anastomosis
    • Some minor leakage of urine or blood-stained discharge around the catheter is common
    • Uncommon complications include:
    • Damage to major blood vessels or other organs during surgery
    • Incisional hernia
  • If you have any concerns following discharge from hospital, within hours you can contact the rooms or the ward to speak to the nurse in charge
  • After hours, you may contact the nurse in charge of the ward or alternatively for major concerns attend your closest emergency department and they should contact your surgeon directly
  • You must insist that nobody removes or adjusts your catheter without prior discussion with your surgeon

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    Where Can I Find Prostate Cancer Support Groups

    Even though once you complete the surgery you most likely will find yourself cancer-free, the anxiety and stress may never totally go away. The support of your friends and family is essential in these moments, but the most relief you will find is among people that have gone through the same experience.

    We advise you to search locally for prostate cancer or cancer survivors support groups and discuss your journey in beating this. You will find there plenty of people that lived through the same emotions and painful experiences and you will gather your strength to overcome this and not let it define the rest of your life.

    If physical presence is not an option for you, there are plenty of forums and online communities that gather around this subject. You can find people that share their experiences and advice below:


    Prostate cancer surgery is not as severe of a surgery as other ones. The recovery, especially after robotic surgery, usually lasts up to 2 to 3 weeks and patients can return to work and to living their normal lives.

    What Is A Robotic Prostatectomy

    Transurethral resection of the prostate (TURP)

    Robotic prostatectomy, or robotic-assisted laparoscopic radical prostatectomy, is the complete surgical removal of the prostate, seminal vesicles, and vas deferens for the treatment of prostate cancer. Compared with the traditional open operation, the procedure is performed through small incisions using the daVinci Surgical System.

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    Mri Technology Revolutionizes Screening Results

    Advances in magnetic resonance imaging technology over the past five years have revolutionized the way we screen men for elevated levels of prostate-specific antigen a protein made in the prostate and released into the bloodstream.

    Men with prostate cancer typically have elevated levels of PSA. Previously, when high levels were detected through a PSA blood test, we would conduct a biopsy to collect and test prostate gland tissue for cancerous cells. This process had several drawbacks:

    • PSA tests can show elevated levels when no cancer is present.
    • Elevated PSA can be a sign of other conditions, such as benign prostate enlargement, a urinary tract infection, or an inflamed prostate gland.
    • Not all prostate cancers are life-threatening, since the cancer is slow growing in many men. Thus, the current goal is to identify patients at high risk of having clinically significant prostate cancer while avoiding unnecessary biopsies in men at low risk.

    Using advanced MRI technology, weve reduced the number of biopsies we perform by almost half while detecting the same number of cancer cases. Getting sharper, clearer MRIs also helps clinicians and patients make better decisions about who should undergo biopsy for prostate cancerand who might benefit from certain treatments, including nerve-sparing robotic prostatectomy.

    Approaches To Radical Prostatectomy Surgeons Can Use Different Approaches And Techniques Toremove The Prostate They Can Make A Large Incision To Reach The Prostate They Can Also Use Laparoscopic Orrobotic Techniques Which Are Done Through Smaller Incisions In The Pelvis Laparoscopicand Robotic Types Of Surgery Are Less Invasive Than An Open Radicalprostatectomy Men Often Have Shorter Recovery Times Less Blood Loss Lesspain And Shorter Hospital Stays With These Procedures Retropubic Radicalprostatectomy Is Done Through An Incision In The Lower Abdomen The Surgeoncan Also Remove Lymph Nodes From The Pelvis Through The Same Incision Incanada A Retropubic Radical Prostatectomy Is The Most Common Approach Toremoving The Prostate To Treat Cancer

    Perineal radical prostatectomyis done through an incision in the area between the scrotum and the anus. This surgery usually doesnt take as long to do as aretropubic radical prostatectomy, but it may lead to more problems with gettingan erection . In addition, surgeons cant removepelvic lymph nodes through the same incision so they would have to do aseparate procedure through a small cut in the lower abdomen to remove them.

    Laparoscopic radical prostatectomyuses a laparoscope and other surgical instruments passed through small cuts. A laparoscopicprostatectomy has some advantages over an open radical prostatectomy, includingless blood loss and pain, shorter hospital stays, faster recovery and less timewith a catheter.

    Robotic radicalprostatectomy is a type of robotic surgery. The surgeon sits near theoperating table and uses remote controls to move robotic arms. The robotic armshave tiny video cameras and surgical instruments that remove tissue throughsmall cuts. The robotic arms can bend and turn like a human wrist. A roboticprostatectomy also has advantages over an open radical prostatectomy includingless blood loss and pain, shorter hospital stays, faster recovery and less timewith a catheter.

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    The Purpose Of Prostate Surgery

    Prostate cancer surgery, or radical prostatectomy, is a procedure conventional medicine praises for curing prostate cancer.

    It has been performed for many years and was regarded as the gold standard of prostate cancer treatment. However, few studies compare its efficacy to other techniques.

    Most men diagnosed with prostate cancer today are typically diagnosed with Gleason 6 cancer levels. But, according to many experts, this diagnosis may not be cancer! According to Mark Scholz, MD, a board-certified oncologist and expert on prostate cancer:

    Misuse of the term cancer has tragic implications. Real cancer requires action and aggressive medical intervention with the goal of saving a life. But consider the potential havoc created by telling someone they have cancer when it is untrue. This dreadful calamity is occurring to 100,000 men every year in the United States with men who undergo a needle biopsy and are told they have prostate cancer with a grade of Gleason 6.

    The impact of this is quite profound. Most prostate cancer diagnosed today falls into this Gleason 6. If it is not cancer, thousands of men have had aggressive treatment for cancer they dont really have.

    Aggressive treatment, usually a complete surgical removal of the prostate , is the typical result. This leaves the patient to suffer from its side effects for the rest of their life.

    Urination And Incontinence In The Postoperative Period

    Robotic Prostatectomy Performed By Dr. Jason Engel

    People who have undergone a prostatectomy will be taught how to operate the catheter before they leave hospital after the operation. The operation of most catheters is relatively similar and involves collecting the urine in a drainage bag, which can then be emptied into the lavatory. The drainage bag must be changed at appropriate intervals.

    All men normally experience some level of incontinence after the catheter has been removed, particularly after involuntary bodily actions such as sneezing or laughing. It is also common to experience sudden impulses to urinate while the catheter is in place. This is called a bladder spasm. Bladder spasms should ideally not be particularly painful or occur very often. Therefore, it is wise to consult the doctor if they occur frequently enough to be bothersome or are accompanied by acute pain.

    For most men, urinary problems are temporary and are effectively resolved by practicing pelvic floor and Kegel exercises regularly, as recommended by the doctor. Pads should be worn whilst urinary leakage is occurring and changed throughout the day as needed.

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    Drinking Plenty Of Water

    This will help ensure that the urinary system functions as healthily as possible while it is recovering from surgery and will also keep the body hydrated. Taking care to stay hydrated is also necessary, because the affected person will be using stool softener in the postoperative period to avoid constipation.


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