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Robotic Prostatectomy

In this surgery, the whole prostate containing the cancer needs to be removed so as to achieve the best possible cure and prevent the cancer from spreading. The da Vinci robot is ideal for this surgery due to the 3-dimensional, 10 times magnified view and small, dextrous instruments that can get right down to the tight pelvic space.  The surgeon is able to remove the whole prostate with less risk of damage to the nerves for erection and sphincter for urinary continence. Robotic method gives faster recovery with less pain and minimal bleeding. The surgery is normally done after 1 month post-biopsy to allow for the post-biopsy adhesions to settle.

The whole prostate is detached from the bladder and urethra

How it is done

Under general anaesthesia, the abdomen is distended with gas and robotic and assistant ports inserted under direct vision. A total of 6 incisions are made. The patient is then placed in a steep head-down position and the robot docked in between the legs. The bladder is taken down to expose the prostate. The prostate gland is detached from the bladder together with its vas and seminal vesicles. The nerves for erection are spared where possible. The bladder is then re-joined to the urethra in a watertight fashion over a catheter. The prostate is put in a plastic bag and retrieved from the umbilical incision. The surgery takes between 2 to 3 hours. Hospital stay is 3 days on average.

Patient position in robotic prostatectomy

Robotic arms in position in between the legs

The bladder is re-joined to the urethra after the prostate is removed

The catheter is removed 1 week later in the clinic, provided the urine is clear yellow. There is no need to do a cystogram xray to confirm water-tight healing of the bladder and urethra unless the urine is still bloody.

Dr Chin doing robotic prostatectomy on the da Vinci S robot

Scars after robotic prostatectomy for a 110 gm prostate cancer in a 57 year old man

Watch video on Nerve Sparing Robotic Prostatectomy

 

Complications include:

  • urine leak. This occurs if the bladder-urethra stitching is not water-tight
  • bleeding. This is usually < 200 ml
  • urinary incontinence. This is due to weak or damaged pelvic floor muscles
  • impotence. This is due to damage of the nerves to the penis.
  • rectal injury. This can occur when dissecting the prostate from the rectum. It is more likely to occur if the adhesions from the biopsy are dense e.g. within a month from biopsy

Desired outcomes:

  • negative surgical margins (this depends on stage of cancer & prostrate size)
  • no anastomotic leak or late strictures ( < 1% risk )
  • no blood transfusion ( <1% occurrence )
  • no permanent stress incontinence (<1% risk)
  • no impotence – this depends on the age of patient and whether both or one nerves have been spared
  • no rectal injury ( < 0.1% risk)