What to Expect from a da Vinci® Procedure
Undergoing 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® Surgery. It aims to help reduce anxiety by providing clear information on what you should expect from your procedure.
The following “What to Expect” steps are for patients having a 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.
2. Further Testing
Further testing by a urologist likely includes 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 schedules a biopsy to be on the safe side. The biopsy is performed by inserting a tubular hollow needle in the rectum, and collecting 5-6 “cores” of tissue from each side of the prostate. Although many patients tolerate the biopsy without medication, the urologist may offer something to ease any discomfort and/or anxiety associated with this procedure.
3. Treatment Options
If physicians are confident that the cancer has not spread beyond the prostate, there is usually a range of treatment options available. These may include but are not necessarily 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 options depend on a number of factors, including the stage of the disease, the patient’s age, his health or personal preference. During the decision-making process, the patient may meet with more than one urologist to discuss concerns including the urologists’ experience, number of patients treated and outcomes data. Urologists may specialize in radiation treatment, surgery or both.
If he chooses surgery, the patient will have a pre-surgical physical examination. The surgeon 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, the patient follows instructions for bowel preparation as provided by the doctor.
5. Day of Surgery
Shortly before the operation, anesthesia is administered and the patient goes to sleep for the duration of the operation, which typically lasts 2-4 hours. The procedure begins when the patient’s abdomen is inflated with carbon dioxide gas, creating an operating space for the surgeon. Next, six small incisions (1/4 to 1/2 in.) are made in the patient’s abdomen and ports are placed to keep the incisions open and to insert the endoscopic camera and instruments.
During the procedure, the surgeon uses the da Vinci System’s laparoscopic surgical instruments and video camera, via the ports, to perform the dissection of the prostate gland and adjacent tissue. If deemed appropriate, the surgeon tries to preserve the nerves attached to the patient’s prostate gland. At the end of surgery, the ports are removed from the patient’s 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.
The patient wakes up with a urinary catheter in place. He will likely spend one night in the hospital resting and recovering from the effects of the anesthesia. As the anesthesia wears off, there may be some discomfort, for which pain medication is usually prescribed. During this time, the medical team gets the patient sitting, standing and then walking around, which is recommended throughout the recovery period. Because a catheter typically remains in place for approximately 7 days, the doctor will review guidelines for use that will minimize 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. Straining and heavy lifting is discouraged for the first four weeks after surgery in order to promote healing internally.
Approximately one week after surgery, a post-operative follow-up is scheduled, at which time bladder function may be assessed. This is done by filling the bladder with saline via the catheter, removing the catheter and then allowing the patient to urinate naturally. Some incontinence after surgery is normal and is typically managed with medication until bladder control resumes. Erectile dysfunction may also be a side effect of surgery. Like incontinence, this side effect may be discussed with the doctor and managed with medication until it lessens or completely goes away over time.
8. Follow-Up Care
After treatment for prostate cancer, the doctor will monitor the patient carefully, checking PSA to see if his cancer returns or spreads. The doctor should also outline a follow-up plan. This plan usually includes regular doctor visits, PSA blood tests and digital rectal exams, which usually begin within a few months of finishing treatment. Doctors often recommend PSA tests every few months following treatment before returning to yearly testing.1
*Compared to open surgery
- American Cancer Society; Prostate Cancer. Available from: http://www.cancer.org/cancer/prostatecancer/detailedguide/prostate-cancer-treating-p-s-a-levels-after-treatment
All surgery presents risk, including da Vinci Surgery. Results, including cosmetic results, may vary. Serious complications may occur in any surgery, up to and including death. Examples of serious and life-threatening complications, which may require hospitalization, include injury to tissues or organs; bleeding; infection, and 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. Patients should understand that risks of surgery include potential for human error and potential for equipment failure. Risk specific to minimally invasive surgery may include: a longer operative time; the need to convert the procedure to an open approach; or the need for additional or larger incision sites. Converting the procedure to open could mean a longer operative time, long time under anesthesia, and could lead to increased complications. Research suggests that there may be an increased risk of incision-site hernia with single-incision surgery. Patients who bleed easily, have abnormal blood clotting, are pregnant or morbidly obese are typically not candidates for minimally invasive surgery, including da Vinci Surgery. Other surgical approaches are available. Patients should review the risks associated with all surgical approaches. They should talk to their doctors about their surgical experience and to decide if da Vinci is right for them. For more complete information on surgical risks, safety and indications for use, please refer to http://www.davincisurgery.com/da-vinci-surgery/safety-information.php.
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PN 873905 Rev A 02/12 U 7/09/2012