Robotic-assisted radical prostatectomy

Robotic-assisted radical prostatectomy is a modern method employed in the surgical treatment of prostate cancer. Utilising state-of-the-art robot technology, this procedure offers enhanced precision, minimised blood loss, and an optimised recovery process, thus representing a significant advancement in prostate cancer treatment.

Robotic-Assisted Radical Prostatectomy, often abbreviated to RARP, is a procedure that utilises a surgical robot to remove the prostate gland and its surrounding tissues. This minimally invasive approach improves upon traditional methods by offering the surgeon enhanced precision and control.

RARP is commonly performed when prostate cancer has been detected and has not spread beyond the prostate gland. It aims to remove the cancerous prostate gland entirely, thus preventing the further spread of cancerous cells.

Preparing for Surgery

Prior to the surgery, Dr Deanne will conduct a comprehensive evaluation of your health and medical history, which includes essential tests such as blood and urine analysis, to assess your fitness for surgery. This is a necessary step to ensure a safe surgical outcome. In addition, you may be asked to stop taking certain medications . Moreover, you will need to consult a specialist continence physiotherapist for pelvic floor exercises. These exercises are crucial as they help in strengthening your pelvic muscles, thereby aiding in a quicker recovery and better control over urinary functions post-operation.

The Surgical Procedure

Throughout the operation, the surgeon skilfully manipulates an advanced robotic system from a console located within the operating theatre. This state-of-the-art robotic technology ingeniously converts the surgeon's larger hand movements into meticulous, finely adjusted actions performed by miniaturised surgical instruments. These instruments are entered into the patient's abdomen through a series of minor incisions.

The procedure commences with the surgeon making these small incisions in the abdominal area. Once the robotic instruments are securely in place inside the patient's body, they are precisely directed by the surgeon's console movements to perform the main surgery – removal of the prostate gland. Any tissues that are suspected to be cancerous are also carefully extracted during this phase of the operation.

A crucial aspect of the surgery is the nerve-sparing approach. This technique involves meticulously working around two bundles of nerve fibres that are situated on either side of the prostate gland and are responsible for penile erections. By utilising the enhanced visualisation and improved precision provided by the robotic system, the surgeon aims to preserve these nerves to the maximum extent possible, thus reducing the risk of erectile dysfunction post-operation.

The procedure also involves the delicate task of rejoining the bladder to the urethra after the removal of the prostate gland. This “bladder-urethra anastomosis” is performed with precision and care, ensuring minimal damage to surrounding tissues. The advanced robotic system offers superior visualisation and control, making it possible to perform these complex tasks with extraordinary accuracy. The intention is to thoroughly remove the cancerous cells from the prostate gland while aiming to maintain the highest possible quality of life for the patient after the operation.

Post-Surgical Care and Recovery

In the immediate aftermath of the surgery, a catheter, which is a thin tube, will be inserted into your bladder through the penis to help your body drain urine. This is a common part of the post-surgical process, given the invasive nature of the operation. The catheter works by bypassing the usual process of urine flow, providing a direct pathway from your bladder to an external collection bag. Your medical team will explain in detail how to care for your catheter, ensuring you're comfortable with maintaining hygiene and managing daily activities with it.

The catheter typically remains in place for seven to ten days, during which time your urinary tract will be healing. After sufficient recovery, you'll return to the clinic to have the catheter removed by our nurse, a process that is generally straightforward and minimally uncomfortable.

As for the return to daily routines such as work and exercise, it largely depends on the nature of your job and the intensity of the physical activities. Generally, patients can return to work after two to three weeks post-surgery, assuming it is not overly strenuous. Light exercise, like walking, can be resumed as soon as you feel up to it post-surgery, but more intense activities, such as heavy lifting or vigorous sports, should be avoided for at least six weeks. It's essential to listen to your body and consult your doctor before resuming any strenuous activities to avoid complications and ensure optimal healing.

Sexual Function Post-Surgery

While nerve-sparing techniques aim to maintain sexual function post-surgery, some men may still experience changes. Dr Deanne will discuss the potential impacts and available treatment options to manage these changes.

Post surgery, you will no longer produce semen, making natural conception impossible. This is because the prostate gland and seminal vesicles, which produce much of the fluid in semen, are removed during surgery. It's noteworthy that this doesn't affect the ability to enjoy a fulfilling sex life, although the sensation of orgasm may feel different without semen.

For men who wish to father children after surgery, options such as sperm banking or assisted reproductive technologies should be considered and discussed with a healthcare provider before the operation. Dr Deanne will cover this with your prior to operating.

Some patients may notice a slight decrease in penis length after the surgery. This is typically temporary and is believed to be due to the shortening of the urethra when a section containing the prostate gland is removed. Loss in length is usually recovered within a year post-surgery.

Continence Post-Surgery

In the initial weeks following surgery, you may experience urinary incontinence. However, the majority of men regain bladder control within a few months. Rehabilitation techniques, including pelvic floor exercises, can aid in restoring normal bladder function.

The journey through prostate cancer treatment can be challenging, but rest assured that you are not alone. With the right information and support, you can navigate this path confidently. Remember, your medical team is there to help, so never hesitate to ask questions or seek clarification.

Ongoing Treatment

Following your operation, Dr Deanne will undertake a series of PSA tests to keep a watchful eye on your condition. PSA (prostate-specific antigen) is a substance made by the prostate gland and its levels can be accurately gauged using blood tests. Typically, prostate cancer is localised to the prostate, making surgical removal a potentially definitive treatment.

After a successful surgery, it is expected that PSA levels will be barely noticeable or completely undetectable in your bloodstream. However, should there be an increase in PSA levels post-surgery, it can be indicative of a recurrence of prostate cancer. Should such a situation arise, Dr Deanne will initiate a thorough discussion about next steps, which may include additional diagnostic imaging and potential treatments. Treatment options could encompass radiotherapy or pharmaceutical interventions to manage the condition effectively.