Robot-Assisted Laparoscopic Prostatectomy

• The surgeon will make an incision in your abdomen. This is usually an up-and-down incision in the midsection of your abdomen. The incision will extend through the inside lining of your abdomen (peritoneum).

• Parts of your prostate will be resected using the cutting edge of the resectoscope.

Many professionals in the field suggest that the entire prostrate be removed for a decrease in the reoccurrence of cancer in the body.

You will be given a medicine to make you sleep through the procedure (general anesthetic).

According to Penn Medicine, robotic-assisted surgery is a minimally invasive surgery in which instruments and cameras are inserted using small incisions. What is different, however, is that the surgeon is sitting at a station next to the patient (Penn Medicine, 2015). During these procedures, robotic ‘arms’ are manipulated using hand and foot controls to perform the procedures. It is always important to note that it is the surgeon performing the surgery, not the robot. These, like any other instruments, are tools that are designed for use by those that are skilled in using them. An expertise in using robotics is essential so as to have success for the procedure.

○ Changing or stopping your regular medicines. This is especially important if you are taking diabetes medicines or blood thinners.

A supracervical hysterectomy is a surgery to remove the top part of the uterus while leaving the cervix in place. The surgery is sometimes done with another procedure to remove the fallopian tubes and ovaries (bilateral salpingo-oophorectomy). You will no longer have menstrual periods or be able to get pregnant after this surgery.

An incision is made in the cyst or abscess so that the fluid drains out. A catheter may be placed inside the cyst so it does not close and fill back up with fluid. The catheter will be removed after following up with a specialist (gynecologist).

The anal sacs will need to be lavaged with an anti-septic solution to prevent the spread of any infection. The tip of a catheter known as the 6-French will then be placed into the rectum. The rectum will need to be packed with saline saturated gauze, to protect the surgical site from contamination. Once this is done, the foley catheter will need to be filled with saline until the anal sacs are easily palpated. Surgical scissors will then be used to make and incision down the wall of the anal sac. With slight pressure placed on the catheter during this insicion, the anal sac should easily be removed. Once the anal sac has been removed the duct that is connected will need to be removed as well. After this is done, the pocket in which the anal sac was removed from will have to be lavaged with saline several times. Now the wound will be sutured with either a 3-0 or 4-0 suture. The patient will then be sent to recovery and all vitals will be

A urinary catheter is a thin tube that is placed in the bladder to allow urine to drain. Urine flows through the tube into a collection bag. A urinary catheter is often used for several purposes: including the inability to void on one’s own, unconscious patient, unable to ambulate, malformation exists that prevents the flow of urine, or to keep an accurate record of the amount of urine being voided. Foleys are also inserted during the surgical process, as seen in most critical care patients for accurate measuring of urine output. During the intensive care admission, patients who have a urinary catheter are more prone to acquiring a urinary tract infection than patients without a catheter inserted (NICHE, 2012).

You will be awake during this procedure. You will sit or lay in a bed or chair.

Robot-assisted laparoscopic radical prostatectomy (RALRP) has become the most common approach to radical prostatectomy (RP) in the United States. With nearly 90% of radical prostatectomies being performed robotically some argue RALP has become the new standard of care 1,2. Robot assistance has been shown to reduce operative time compared with laparoscopic prostatectomy (LRP) and in general, it has liberated LRP for non–fellowship-trained urologists at non–high-volume centers 3,4. Several reports have attempted to characterize the ‘‘learning curve’’ associated with RALRP. Metrics used to characterize the RALRP learning curve have ranged from operative time and blood loss to positive surgical margin (PSM) rate. Learning curves have been reported to range from 30 to over 200 cases 5,6. Although a comprehensive learning curve for open radical retropubic prostatectomy (RRP) was recently delineated by a high-quality, multicenter study, a comprehensive RALRP-specific learning curve has not been clearly defined 7-9.

The catheter once removed, will have compression done over the insertion point to allow haemostasis.

Prostatectomy covers several surgical procedures to remove all or some of the prostate gland. The prostate gland is located in the lower abdomen of men, beneath the urinary bladder. It surrounds the urethra, which transfers urine from the bladder to the penis. There are different prostatectomy procedures depending on the treatment required. These include robotic-assisted radical prostatectomy, open radical prostatectomy, laparoscopic radical prostatectomy, and Open simple prostatectomy.

Technology is transforming the medical field with the design of robotic devices and multifaceted imaging. Even though these developments have made operations much less invasive, robotic systems have their own disadvantages that prevent them from replacing surgeons all together. Minimally Invasive Surgery (MIS) is a broad notion encompassing a lot of common procedures that existed prior to the introduction of robots. It refers to general procedures that keep away from long cuts by entering the body through small, usually about 1cm, entry incisions, through which surgeons use long-handled instruments to operate on tissue inside the body. Such operations are directed by viewing equipment and, therefore, do not automatically need the use of a robot. Yet, it is not incorrect to say that computer-assisted and robotic surgeries are categories that fall under minimally invasive surgery (Robotic Surgery, n.d.).