Da-Vinci robotic radical prostatectomy surgery: 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 surgeon-controlled robot to perform the removal of 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 robot-assisted surgical system called 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 provides a three-dimensional view. Through small incisions in the patient's abdomen, the robotic arms are inserted and the surgeon can perform the prostatectomy.

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

When is robotic radical prostatectomy recommended?

Robotic radical prostatectomy is generally recommended in the following cases:

  • Localized prostate cancer: Radical prostatectomy, either by 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 surgery of this type. Factors such as age, heart condition, lung function and ability to recover from surgery should be taken into account.
  • Patients with reasonable life expectancy: Because prostate cancer generally develops slowly, robotic radical prostatectomy is recommended for patients with a reasonable life expectancy, meaning they are likely to live long enough to benefit from the surgery and avoid long-term prostate cancer-related complications.
  • 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 his or her medical team. Some patients may have personal preferences based on their lifestyle, treatment goals and their tolerance for risks and side effects.

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

Benefits and risks of radical prostatectomy using the da Vinci robot

Robotic radical prostatectomy offers several significant benefits over 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 a more precise removal of the prostate and reduced damage to surrounding tissues, such as the nerves responsible for erectile function and urinary continence.
  • Reduced bleeding and risk of complications: Robotic radical prostatectomy is associated with less blood loss during surgery, reducing the need for blood transfusions. In addition, being 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 and less visible scars. In addition, patients typically experience less postoperative pain and require less pain medication.
  • Faster recovery: Robotic surgery allows for faster recovery compared to conventional open surgery. Patients often have a shorter hospital stay and can resume normal activities, including work and exercise, in less time. A reduction in the time required for recovery of 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 keep in mind that the benefits may vary depending on the patient and the surgeon's experience.

Preparation prior to radical prostatectomy by Da Vinci robotics

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

  • Consultation with the medical team: Prior to surgery, a consultation will be held with both our team. During this consultation, the details of the procedure will be discussed, diagnostic test results will be reviewed and any questions or concerns the patient may have will be answered. Also at this consultation, aftercare following surgery will be discussed, including the expected length of hospitalization, wound care, recovery and any additional therapy that may be necessary, such as physical therapy or rehabilitation.
  • Anesthetic evaluation and preoperative testing: A complete anesthetic evaluation will be performed to assess the patient's overall health and ensure that he/she is fit for surgery. This may include blood work, electrocardiogram, pulmonary function tests and any additional tests needed.
  • Medication: The patient's current medication will be reviewed and instructions will be provided as to which medications should be discontinued or continued prior to surgery. This may include anticoagulant medications, antiplatelet medications, or other medications that may affect blood clotting.
  • Fasting Instructions: Specific fasting instructions 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 provides a three-dimensional view are inserted. The surgeon controls the precise movements of the robot 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 surgeon's experience and the patient's anatomical characteristics. 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 required for preoperative preparation and awakening after anesthesia.

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

Postoperative period and possible side effects of robotic radical prostatectomy

The postoperative period following a robotic radical prostatectomy involves a series of care and medical follow-up to ensure an adequate recovery. Although side effects may vary from patient to patient, here are some common aspects to expect:

  • Pain: It is normal to experience some degree of pain or discomfort in the incision area and pelvic region after surgery. Analgesics help control the pain, and it usually decreases gradually over time.
  • Urinary catheter: After robotic radical prostatectomy, a urinary catheter is placed and maintained for 10-15 days.
  • Urinary problems: It is common to experience temporary bladder control difficulties after surgery, such as urinary incontinence or frequent urination. These problems usually improve with 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 intracavernous injections.
  • Constipation: Some patients may experience temporary constipation due to reduced physical activity, intake of analgesics and dietary changes. Dietary changes, increased fiber intake and the use of mild laxatives may be recommended to relieve constipation.

After surgery, patients usually 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 removal of the prostate gland?

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 removal, PSA levels in the blood should decrease significantly.

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

It is important to note that 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 checks based on the patient's individual risk.

Urology clinic in Madrid specialized in robotic radical prostatectomy.

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

The Ramirez Urology team understands the importance of personalized attention, effective communication and a comprehensive approach to patient care. In addition, they stay up-to-date on the latest advances and techniques in robotic surgery, which allows them to provide the most advanced and quality care to their patients.

In summary, by choosing a team of professional and experienced urologists, backed by state-of-the-art 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 successful robotic radical prostatectomy and optimal recovery.