Robotic Radical Prostatectomy
What is a Robotic Radical Prostatectomy?
Robotic Radical prostatectomy or Robot-assisted Radical prostatectomy (RARP) is a surgical procedure by which the prostate gland and its surrounding structures and tissues are removed. These structures can include both lymph nodes as well as seminal vesicles.
By using a robotic-assisted laparoscopic (key-hole using a computer interface) procedure the surgeon aims to remove all cancer and retain the patient’s continence (urinary control) and potency (erectile function).
This surgery is currently the gold standard for treating cases of localised prostate cancer. It is a highly effective treatment with good long term results in the appropriately selected patient.
Along with the removal of the malignancy, the surgery results in symptom relief in some patients caused by prostate cancer or enlarged prostate such as difficulty in urination, dribbling or frequency symptoms.
Robotic Radical Prostatectomy Benefits
Robotic approaches have proven to offer:
- an enhanced, faster recovery with minimal pain,
- less blood loss, with minimal transfusion risk,
- potentially improved functional outcomes such as continence (urinary control) and potency (erectile function).
Robot-Assisted Radical Prostatectomy (RARP) Animation
Preparation Before a Radical Prostatectomy
In order to prepare for the surgery, the patient should be adequately counselled to ensure that the informed consent obtained is fully understood.
Dr Kim’s team will liaise with his own dedicated and experienced pelvic floor physiotherapy team to enhance continence recovery after surgery.
Dr Kim and his team then runs a number of tests to ensure that the patient is fit and in good health for the surgery. These will include thorough medical assessment (history, physical examination, investigations such as blood work, urine analysis, and various imaging scans if needed). If further work up is required Dr Kim’s team will arrange this and make the final call for eligibility based on the above information. He will also ensure every patient is reviewed by his experienced pelvic floor physiotherapy team for optimal continence outcomes.
This is a major surgery and the patient is advised not to eat anything for six hours before the procedure.
Operative Steps
Dr Kim uses the latest generation Da Vinci Robot and may show the robot to the patient before the surgery in order to relieve any associated anxiety and answer any related questions.
The surgical procedures include the following steps:
- Anaesthetist places an IV line for various anaesthetic drug and fluid instillation and puts you to sleep to enable safe and comfortable procedure.
- Dr Kim operates the robot next to patient’s bed and his surgical team using the surgeon console.
- Keyhole incisions are made in the abdomen for the robotic arms and camera to allow Dr Kim to see the internal view and perform surgery.
- Once inside, the robot arms are manipulated to move various structures and organs out of the way until the prostate gland is reached.
- The bladder is taken down to access the prostate.
- The prostate tissue is dissected in sequence and removed with vas and seminal vesicles.
- The maximal length of the urethra will be spared to help with continence.
- The bladder and urethra are joined together and leak test is performed to ensure for watertight closure.
- The robotic devices and camera are removed and the initial incisions are sutured.
- The patient is brought out of anaesthesia and placed in post-operative care.
Robotic Radical Prostatectomy Outcomes
Dr Kim will aim to achieve the following surgical outcomes (‘Trifecta’) and analyse his outcomes:
- Negative surgical margins and cancer free status
- Continence (pad free) rates
- Potency (erection and intercourse) rates
Positive Surgical Margins
When the prostate is removed it is covered in ink to mark where the surgeon has cut. It is then examined under the microscope. If cancer cells
- Touch the ink, then this may indicate that not all of the cancer cells have been cleared and some has been left behind. This is termed a “positive margin”.
- Do not touch the ink then this is a “negative margin”.
The first aim of radical prostatectomy, before any other, is to achieve a negative margin.
If cancer has extended outside of the Prostate Gland into the adjacent tissue then the chance of a positive margin increases. However, in cases where the cancer is confined to the prostate gland, the positive margin rate is very low.
After a Radical Prostatectomy
The patient is kept in the recovery room for observation and their vitals are monitored. The patient is moved to a room in a few hours, and he can begin to take liquids.
The surgical site will be kept clean and bandages will be changed as needed.
A drain is usually removed next day and the patient is normally discharged within 48 hours if everything looks good.
Specific instruction for bathing will also be advised.
Until notified, driving is discouraged, along with strenuous physical activities.
Care Plan After a Radical Prostatectomy
Dr Kim will devise a care plan for the patient for the next few months, to monitor cancer status and help improve bladder control.
Dr Kim will also advise follow-up visits to check the patient’s progress and his compliance with pelvic floor physiotherapy and restoration of sexual function.