What to Expect from a da Vinci® Procedure
Having any type of surgery can cause anxiety. Facing surgery that is new or unfamiliar may raise additional questions for patients. This section explains what happens before, during and after minimally invasive robotic-assisted da Vinci® Prostatectomy.
1. Initial Appointment
Many men go to a primary care physician for a routine check-up, only to get a call later saying their laboratory results showed an "elevated PSA." They are usually told that further testing needs to be conducted by a specialist known as a urologist.
Further testing by a urologist may include a standard digital rectal exam (DRE), in which the doctor manually feels the prostate by way of the rectum. Even if the urologist detects nothing abnormal, he/she usually may schedule a biopsy to be on the safe side. During the biopsy which is performed through the rectum, your doctor collects tissue from each side of the prostate. Although many patients have the biopsy without medication, your urologist may offer something to ease any discomfort and/or anxiety.
If physicians are confident that the cancer has not spread beyond the prostate, there are several treatments and surgical options available. These may include but are not limited to: surgery to remove the prostate (known as radical prostatectomy); radiation external beam or radioactive seed implants); watchful waiting; cryosurgery and/or hormonal therapy.
Treatment and surgical options depend on a number of factors, including the stage of the disease, your age, health or personal preference. During the decision-making process, you may meet with more than one urologist to discuss concerns including the urologists' experience, number of patients treated and outcomes. Urologists may specialize in radiation treatment, surgery or both.
If you choose to have a da Vinci Prostatectomy, you will have a pre-surgical physical exam. Your doctor may prescribe special pre-surgical exercises, diet and/or medication. He will discuss the details of the procedure with the surgeon. The surgeon will also arrange an appointment with the anesthesiologist, usually the week before surgery. The evening before surgery, you will have to follow instructions for bowel preparation as provided by the doctor.
5. Day of Surgery
Shortly before the operation, anesthesia is administered and you go to sleep for the entire operation, which typically lasts 2-4 hours. Surgery begins when your abdomen is inflated with carbon dioxide gas, creating an operating space for the surgeon. Next, small incisions (1/4 to 1/2 in.) are made in your abdomen and ports are put in place to keep the incisions open and to insert the endoscopic camera and surgical instruments.
The surgeon uses the da Vinci System's instruments and video camera, via the ports, to perform the dissection of the prostate gland and adjacent tissue. When possible and appropriate, the surgeon tries to preserve the nerves attached to your prostate gland. At the end of surgery, the ports are removed from your abdomen and the remaining incisions are closed with sutures or bandages.
For detailed information about this procedure, talk to a surgeon who performs da Vinci Prostatectomy.
You will have a urinary catheter in place when you wake up. You will likely spend one night in the hospital resting and recovering from the effects of anesthesia. As the anesthesia wears off, there may be some discomfort, and pain medication is usually prescribed. During this time, the medical team gets you sitting, standing and then walking around, which is recommended throughout the recovery period. Because a catheter remains in place for several days, your doctor will review guidelines for use that will ease any discomfort and ensure proper function of the catheter during this time.
7. Recovery Period
The first week post-operatively will likely be spent resting; however, frequent walks are encouraged. Depending on the individual, regular activities may resume as soon as a few days after surgery but straining and heavy lifting is discouraged for the first four weeks after surgery to promote healing internally.
Approximately one week after surgery, a follow-up doctor’s visit is scheduled. During this time, your doctor will examine how your bladder is functioning. Some incontinence after surgery is normal and is often managed with medicine until your bladder control resumes. Erectile dysfunction may also be a side effect of surgery. Like incontinence, this side effect should be discussed with the doctor and managed with medicine until it lessens or completely goes away over time.
8. Follow-Up Care
After treatment for prostate cancer, the doctor will monitor you carefully, checking your PSA to see if cancer returns. The doctor should also outline a follow-up plan. This plan usually includes regular doctor visits, PSA blood tests and digital rectal exams.
All surgery presents risk, including da Vinci® Surgery and other minimally invasive procedures. Serious complications may occur in any surgery, up to and including death. Examples of serious or life-threatening complications which may require hospitalization include injury to tissues or organs, bleeding, infection or internal scarring that can cause long-lasting dysfunction or pain. Temporary pain or nerve injury has been linked to the inverted position often used during abdominal and pelvic surgery. Risks of surgery also include potential for equipment failure and human error. Risks specific to minimally invasive surgery may include: A long operation and time under anesthesia, conversion to another technique or the need for additional or larger incisions. If your surgeon needs to convert the procedure, it could mean a long operative time with additional time under anesthesia and increased complications. Temporary pain or discomfort may result from pneumoperitoneum, the presence of air or gas in the abdominal cavity used by surgeons in minimally invasive surgery. Research suggests that there could be an increased risk of incision-site hernia with single-incision surgery. Results, including cosmetic results, may vary. Patients who bleed easily, who have abnormal blood clotting, are pregnant or morbidly obese are typically not candidates for minimally invasive surgery, including da Vinci® Surgery. For more complete information on surgical risks, safety, and indications for use, please refer to http://www.davincisurgery.com/safety/. Patients should talk to their doctors about their surgical experience and to decide if da Vinci Surgery is right for them. Other options may be available. Intuitive Surgical reviews clinical literature from the highest level of evidence available to provide benefit and risk information about use of the da Vinci Surgical System in specific representative procedures. We encourage patients and physicians to review all available information on surgical options and treatment in order to make an informed decision. Clinical studies are available through the National Library of Medicine at www.ncbi.nlm.nih.gov/pubmed.
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