Radical prostatectomy surgery using Da-Vinci robotics: benefits, procedure and postoperative period

Radical Prostatectomy using the Da Vinci robotic system (RARP) is a technological advance in the field of urological surgery. This surgical technique uses a robot controlled by a surgeon to remove the prostate affected by cancer.

This technique has become a preferred option for many patients and surgeons, significantly improving patient outcomes and quality of life.

What is robotic radical prostatectomy?

Robotic radical prostatectomy is a surgical procedure that uses advanced robotic technology to remove the prostate in cases of localized prostate cancer. Instead of performing conventional open surgery, which involves an abdominal incision, this technique uses a surgical system assisted by robot named Da Vinci.

The Da Vinci system consists of a console from which the surgeon controls the precise movements of the robotic arms. These arms are equipped with miniaturized surgical instruments and a high-definition camera that offers three-dimensional vision. Through small incisions in the patient's abdomen, robotic arms are introduced and the surgeon can perform the prostatectomy.

During surgery, the surgeon sits at the console and views a magnified, three-dimensional image of the surgical area. The movements of the surgeon's hands are translated into precise movements of the robotic arms, allowing for precise removal of the prostate and preservation of surrounding tissues, such as the nerves responsible for erectile function and urinary continence.

When is it recommended to apply robotic radical prostatectomy?

Robotic radical prostatectomy is generally recommended in the following cases:

  • Localized prostate cancer: Radical prostatectomy, either through open or robotic surgery, is the standard treatment for localized prostate cancer, that is, when the cancer is confined within the prostate and has not spread to other areas of the body. In these cases, robotic radical prostatectomy may be an appropriate option.
  • Patients in good general health: Robotic radical prostatectomy is performed in patients who are in good general health and can tolerate such surgery. Factors such as age, heart condition, lung function, and ability to recover from surgery must be taken into account.
  • Patients with reasonable life expectancy: Since prostate cancer generally develops slowly, robotic radical prostatectomy is recommended in patients with a reasonable life expectancy, meaning they are likely to live long enough to benefit from surgery and avoid complications related to prostate cancer. long-term prostate.
  • Patient preference: The choice of treatment, including robotic radical prostatectomy, may also depend on the patient's preferences after discussing the risks and benefits with their medical team. Some patients may have personal preferences based on their lifestyle, treatment goals, and tolerance for risks and side effects.

It is important to highlight that the decision to perform a robotic radical prostatectomy must be individualized and based on a complete evaluation of each particular case.

Benefits and risks of radical prostatectomy using the Da Vinci robot

Robotic radical prostatectomy offers several significant benefits compared to conventional open surgery and other minimally invasive approaches. Some of the key benefits are:

  • Surgical precision: The Da Vinci robotic system provides high-definition three-dimensional vision and magnification capability, allowing the surgeon to perform precise and delicate movements. This results in more precise removal of the prostate and reduced damage to surrounding tissues, such as the nerves responsible for erectile function and urinary continence.
  • Less bleeding and risk of complications: Robotic radical prostatectomy is associated with less blood loss during surgery, reducing the need for blood transfusions. Furthermore, as it is a minimally invasive technique, a reduction in the risk of postoperative complications, such as infections and incisional hernias, has been observed.
  • Reduced scars and pain: The incisions made in robotic radical prostatectomy are small compared to traditional open surgery, resulting in smaller, less visible scars. Additionally, patients typically experience less postoperative pain and require fewer pain medications.
  • Faster recovery: Robotic surgery allows for a faster recovery compared to conventional open surgery. Patients typically have a shorter hospital stay and can return to normal activities, including work and exercise, in less time. A reduction in the time needed to recover urinary and sexual function has also been observed.
  • Preservation of urinary and sexual function: Robotic radical prostatectomy allows the surgeon greater precision in preserving the nerves that control erectile function and urinary continence. This has led to better results in terms of preservation of sexual and urinary function compared to conventional open surgery.

It is important to note that benefits may vary depending on the patient and the surgeon's experience.

Preparation prior to radical prostatectomy using Da Vinci robotics

Preparation prior to radical prostatectomy using Da Vinci robotics generally includes the following steps and considerations:

  • Consult with the medical team: Before surgery, a consultation will be carried out with our team. During this consultation, the details of the procedure will be discussed, the results of diagnostic tests will be reviewed, and any questions or concerns the patient may have will be answered. Post-surgery care will also be discussed at this consultation, including the expected length of hospital stay, wound care, recovery, and any additional therapies that may be necessary, such as physical therapy or rehabilitation.
  • Anesthetic evaluation and preoperative tests: A full anesthetic evaluation will be performed to assess the patient's general health and ensure they are suitable for surgery. This may include blood tests, electrocardiogram, lung function tests, and any other additional tests needed.
  • Medication: The patient's current medications will be reviewed and instructions will be provided on which medications to stop or continue before surgery. This may include anticoagulant medications, antiplatelet medications, or other medications that may affect blood clotting.
  • Fasting instructions: Specific instructions regarding fasting will be provided prior to surgery, generally requiring no food or drink after the morning of the day of surgery.

Radical prostatectomy procedure using Da Vinci robotics

The robotic radical prostatectomy procedure involves making several small incisions in the patient's abdomen, through which robotic arms and a high-definition camera that offers three-dimensional vision are inserted. The surgeon controls the robot's precise movements from a nearby console.

How long does a robotic radical prostatectomy take?

The duration of a robotic radical prostatectomy can vary depending on several factors, such as the complexity of the case, the experience of the surgeon, and the anatomical characteristics of the patient. In general, the average surgical time for a robotic radical prostatectomy is usually approximately 1 to 3 hours.

It is important to note that this time does not include the time needed for preoperative preparation and awakening after anesthesia.

It is important to keep in mind that the duration of surgery is not the only factor that influences the patient's recovery. After surgery, a period of observation in hospital will be required and post-operative care will be provided to ensure proper recovery. Each patient is unique and may require different recovery times depending on their health and other individual factors.

Postoperative and possible side effects of robotic radical prostatectomy

The postoperative period of a robotic radical prostatectomy involves a series of care and medical monitoring to ensure adequate recovery. Although side effects can vary from patient to patient, here are some common things to expect:

  • Pain: It is normal to experience some degree of pain or discomfort in the incision area and pelvic region after surgery. Pain relievers help control the pain, and it usually decreases gradually over time.
  • urinary catheter: After robotic radical prostatectomy, a urinary catheter is placed and left in place for 10-15 days.
  • urinary problems: It is common to experience temporary difficulties in bladder control after surgery, such as urinary incontinence or frequent needing to urinate. These problems usually improve over time and may require pelvic floor rehabilitation therapy to strengthen the muscles responsible for urinary control.
  • Erectile dysfunction: Radical prostatectomy can affect erectile function due to manipulation of the nerves that control erection. Recovery of erectile function may be a gradual process, and in some cases, may require additional therapies, such as oral medications or intracavernosal injections.
  • Constipation: Some patients may experience temporary constipation due to reduced physical activity, ingestion of pain relievers, and changes in diet. Dietary changes, increased fiber intake, and the use of mild laxatives may be recommended to relieve constipation.

After surgery, patients typically experience a gradual improvement in their urinary and sexual function as they recover. Regular medical follow-up is essential to monitor the patient's progress and ensure optimal recovery.

It is important to follow postoperative instructions, including wound care, medication, and follow-up checks, to ensure a successful recovery.

What is the normal PSA after prostate gland removal?

After removal of the prostate gland, PSA (prostate-specific antigen) levels should be undetectable or very low. PSA is a protein produced by the prostate, so after its removal, blood PSA levels should decrease significantly.

The exact definition of a “normal” PSA level after radical prostatectomy varies depending on the laboratory and testing technique used. A PSA level less than 0.2 ng/mL is generally considered undetectable or very low. However, some laboratories may use a lower cutoff value, such as 0.1 ng/mL, to consider it undetectable.

Importantly, even after a successful radical prostatectomy, there may be a small amount of residual prostate tissue that can produce low, but detectable levels of PSA. These levels should generally be less than 0.2 ng/mL. If PSA levels after prostatectomy are higher than these values, it may indicate the presence of residual prostate tissue or a possible recurrence of prostate cancer.

It is essential to undergo regular follow-up and post-prostatectomy PSA testing to monitor levels and detect any significant changes. Our team will determine the appropriate frequency of PSA testing based on the patient's individual risk.

Madrid urology clinic specialized in robotic radical prostatectomy

It is crucial to highlight the importance of having professional urologists, such as those who are part of the Ramírez Urology team. These specialists have years of experience and are familiar with the latest technological advances, such as Da Vinci robot, to perform robotic radical prostatectomy with maximum guarantee and safety.

The Ramírez Urology team understands the importance of personalized care, effective communication and the comprehensive approach to patient care. Additionally, they stay up to date on the latest advances and techniques in robotic surgery, allowing them to provide the most advanced, quality care to their patients.

In short, by choosing a team of professional and experienced urologists, supported by cutting-edge technology such as the Da Vinci robot, patients can be confident that they will receive quality treatment and care focused on their individual needs, resulting in a prostatectomy. radical successful robotics and optimal recovery.