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.
Serious complications may occur in any surgery, including da Vinci® Surgery, up to and including death. Examples of serious or life-threatening complications, which may require prolonged and/or unexpected hospitalization and/or reoperation, include but are not limited to, one or more of the following: injury to tissues/organs, bleeding, infection and internal scarring that can cause long-lasting dysfunction/pain. Risks of surgery also include the potential for equipment failure and/or human error. Individual surgical results may vary.
Risks specific to minimally invasive surgery, including da Vinci Surgery, include but are not limited to, one or more of the following: temporary pain/nerve injury associated with positioning; temporary pain/discomfort from the use of air or gas in the procedure; a longer operation and time under anesthesia and conversion to another surgical technique. If your doctor needs to convert the surgery to another surgical technique, this could result in a longer operative time, additional time under anesthesia, additional or larger incisions and/or increased complications.
Patients who are not candidates for non-robotic minimally invasive surgery are also not candidates for da Vinci® Surgery. Patients should talk to their doctor to decide if da Vinci Surgery is right for them. Patients and doctors should review all available information on non-surgical and surgical options in order to make an informed decision. For Important Safety Information, including surgical risks, indications, and considerations and contraindications for use, please also refer to www.davincisurgery.com/safety and www.intuitivesurgical.com/safety. Unless otherwise noted, all people depicted are models.
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