What is Robot Assisted Laparoscopic Prostatectomy

Robot assisted laparoscopic prostatectomy is a minimally invasive procedure to remove the entire prostate gland and the seminal vesicles, which are near the bladder and the prostate.

This procedure is done to treat prostate cancer that has not spread to other parts of the body (has not metastasized). The goal of the procedure is to remove all cancer cells and to prevent prostate cancer from metastasizing.

During your robot-assisted laparoscopic prostatectomy, your surgeon will use a thin, lighted tube with a tiny camera on the end (laparoscope). The laparoscope will allow your surgeon to do the surgery with several small incisions in the abdomen instead of a large incision.

Your surgeon will also use a robotic arm during the procedure that will be operated through a computer.

During your procedure, the lymph glands in your pelvis may be removed. Lymph glands are part of your body’s disease-fighting system (immune system). The lymph glands in the pelvis may be the first place that is affected by the spreading (metastasis) of prostate cancer. If your pelvic lymph glands are removed, tissue from the glands will be tested for cancer cells.

Tell a health care provider about:

• Any allergies you have.
• All medicines you are taking, including vitamins, herbs, eye drops, creams, and over-the-counter medicines.
• Any problems you or family members have had with anesthetic medicines.
• Any blood disorders you have.
• Any surgeries you have had.
• Any medical conditions you have.
• Any prostate infections you have had.

What are the risks?

Generally, this is a safe procedure. However, problems may occur, including:

• Infection.
• Bleeding.
• Allergic reactions to medicines.
• Inability to control when you urinate (incontinence). This is usually a temporary effect of this procedure.
• Blockage (obstruction) of the large or small intestines.
• Narrowing or scarring of the urethra (stricture), which may block the flow of urine.
• Inability to get or sustain an erection (erectile dysfunction).
• Dry ejaculation. This is when no semen is released during orgasm.
• Blood clots in the legs.
• The formation of a sac (cyst) in the pelvis that is filled with fluid from the lymph glands (lymphocele).

There is also a risk of damage to other structures or organs, such as:

• The tubes that drain urine from the kidneys to the bladder (ureters).
• The bladder.
• The urethra.
• The large or small intestines.
• The rectum.
• Vascular arteries or veins.
• Nerve tissue.

What happens before the procedure?

Staying hydrated

Follow instructions from your health care provider about hydration, which may include:

• Up to 2 hours before the procedure – you may continue to drink clear liquids, such as water, clear fruit juice, black coffee, and plain tea.

Eating and drinking restrictions

Follow instructions from your health care provider about eating and drinking, which may include:

• 8 hours before the procedure – stop eating heavy meals or foods such as meat, fried foods, or fatty foods.
• 6 hours before the procedure – stop eating light meals or foods, such as toast or cereal.
• 6 hours before the procedure – stop drinking milk or drinks that contain milk.
• 2 hours before the procedure – stop drinking clear liquids.

Medicines

• Ask your health care provider about:
  • Changing or stopping your regular medicines. This is especially important if you are taking diabetes medicines or blood thinners.
  • Taking medicines such as aspirin and ibuprofen. These medicines can thin your blood. Do not take these medicines before your procedure if your health care provider instructs you not to.
• You may be given antibiotic medicine to help prevent infection.

General instructions

• Ask your health care provider how your surgical site will be marked or identified.
• You may have an exam or testing.
• You may have additional tests, such as a CT scan or MRI.
• You may have a blood or urine sample taken.

What happens during the procedure?

• To reduce your risk of infection:
  • Your health care team will wash or sanitize their hands.
  • Your skin will be washed with soap.
  • Hair will be removed from your surgical area.
• An IV tube will be inserted into one of your veins.
• You will be given one or more of the following:
  • A medicine to help you relax (sedative).
  • A medicine to make you fall asleep (general anesthetic).
  • A medicine that is injected into your spine to numb the area below and slightly above the injection site (spinal anesthetic).
• A thin, flexible tube (catheter) will be inserted through your urethra and into your bladder. The catheter will drain urine from your bladder during the procedure and while you heal.
• Four or five small incisions will be made in your abdomen.
• The laparoscope and other surgical instruments will be put through the incisions. Your surgeon will use the laparoscope and a robotic arm to help control the surgical instruments.
• Your urethra will be cut and separated from your bladder, and your prostate and seminal vesicles will be removed.
• Your pelvic lymph glands may also be removed for testing.
• Your urethra will be reconnected to your bladder. This will be done so your catheter is still in place inside of your urethra.
• A small tube (drain) may be placed in one or more of your incisions to help drain extra fluid from your surgical site.
• Your incisions will be closed with stitches (sutures), skin glue, or adhesive strips.
• Medicine may be applied to your incisions.
• Bandages (dressings) will be placed over your incisions.

What happens after the procedure?

• Your blood pressure, heart rate, breathing rate, and blood oxygen level will be monitored until the medicines you were given have worn off.
• You may continue to receive fluids and medicines through an IV tube.
• You will have some pain. Pain medicines will be available to help you.
• You will have a catheter to drain urine from your bladder.
• You may have fluid coming from a drain in your incision.
• You may have to wear compression stockings. These stockings help to prevent blood clots and reduce swelling in your legs.
• You will be encouraged to move around as much as possible.

Robot-Assisted Laparoscopic Prostatectomy, Care After

This sheet gives you information about how to care for yourself after your procedure. Your health care provider may also give you more specific instructions. If you have problems or questions, contact your health care provider.

What can I expect after the procedure?

After the procedure, it is common to have:

• Mild pain in your lower abdomen.
• Blood in your urine for up to 3 weeks.
• A need to urinate more often than usual (bladder spasms). This may last for up to 2 weeks.

After your catheter is removed, it is common to have:

• A burning sensation when you urinate. This may last for up to 2 weeks after your catheter is removed.
• Difficulty controlling when you urinate (incontinence). You may leak urine occasionally. Your ability to control when you urinate will improve as you continue to heal.

Follow these instructions at home:

Medicines

• Take over-the-counter and prescription medicines only as told by your health care provider.
• Do not drive or use heavy machinery while taking prescription pain medicine.
• If you were prescribed an antibiotic medicine, take it as told by your health care provider. Do not stop taking the antibiotic even if you start to feel better.
• If you were given a stool softener, use it as told by your health care provider.

Incision care and drain care

• Follow instructions from your health care provider about how to take care of your incisions. Make sure you:
  • Wash your hands with soap and water before you change your bandage (dressing). If soap and water are not available, use hand sanitizer.
  • Change your dressing as told by your health care provider.
  • Leave stitches (sutures), skin glue, or adhesive strips in place. These skin closures may need to stay in place for 2 weeks or longer. If adhesive strip edges start to loosen and curl up, you may trim the loose edges. Do not remove adhesive strips completely unless your health care provider tells you to do that.
• If you have a drain, follow instructions from your health care provider about how to care for it. Do not remove the drain tube or any dressings around the tube opening unless your health care provider approves.
• Check your incision sites and drain area every day for signs of infection. Check for:
  • More redness, swelling, or pain.
  • More fluid or blood.
  • Warmth.
  • Pus or a bad smell.

Catheter care

• Always wash your hands with soap and water before and after touching your penis, your catheter, and your drainage bag. If soap and water are not available, use hand sanitizer.
• Empty your drainage bag every 3 hours during the day, or as often as told by your health care provider.
• Clean the tip of your penis with soap and water two times a day, or as often as told by your health care provider.
• If you were given ointment to apply to the tip of your penis, follow instructions from your health care provider about how to do this.
• You will need to visit your health care provider to have your catheter removed. Your catheter may remain in place for up to 3 weeks after your procedure.

Activity

• Return to your normal activities, including driving, as told by your health care provider. Ask your health care provider what activities are safe for you.
• Do not lift anything that is heavier than 10 lb (4.5 kg) until your health care provider says that you can do this.
• Avoid intense physical activity for as long as told by your health care provider.
• Walk at least once a day. As you start to feel better, you may start to exercise more. Ask your health care provider what exercises are appropriate for you.

Eating and drinking

• Follow instructions from your health care provider about eating or drinking restrictions.
• Drink enough fluid to keep your urine clear or pale yellow.

General instructions

• Do not take baths, swim, or use a hot tub until your health care provider approves.
• If your pelvic lymph nodes were removed for testing, it is up to you to get your test results. Ask your health care provider, or the department performing the test, when your results will be ready.
• Wear compression stockings as told by your health care provider. These stockings help to prevent blood clots and reduce swelling in your legs.
• Follow instructions from your health care provider about when it is safe for you to engage in sexual activity.
• Do not strain to have a bowel movement.
• Do not use any products that contain nicotine or tobacco, such as cigarettes and e-cigarettes. If you need help quitting, ask your health care provider.
• Keep all follow-up visits as told by your health care provider. This is important.

Contact a health care provider if:

• You have problems with your catheter.
• You have bladder spasms more than 3 or 4 times a day.
• You become constipated. Symptoms of constipation may include:
  • Having fewer than three bowel movements a week.
  • Difficulty having a bowel movement.
  • Having stools that are hard, dry, or larger than normal.

Get help right away if:

• You have more redness, swelling, or pain around your incisions, drain area, or the area where the catheter was inserted (catheter insertion site).
• You have more fluid or blood coming from your incision area, drain area, or catheter insertion site.
• Your incision area, drain area, or catheter insertion site feels warm to the touch.
• You have pus or a bad smell coming from your incision area, drain area, or catheter insertion site.
• You have a fever.
• You have pain that gets worse.
• Your catheter falls out.
• You are unable to urinate or to pass urine through your catheter.
• You have more bright red blood in your urine.
• You have blood clots in your urine.
• You develop:
  • Chest pains.
  • Shortness of breath.
  • Swelling or pain in your legs.