Advanced Kinds Of Laparoscopic Surgery
In some operations, the surgeon can put the camera and the surgical tool through the same opening in the skin. This means less scarring. But itâs trickier for the surgeon because the instruments are so close together.
In other cases, the surgeon may decide to use a device that lets them reach in with a hand. This is called âhand assistedâ laparoscopy. The cut in the skin has to be longer than a half-inch, but it still can be smaller than in traditional surgery. This has made it possible to use laparoscopic surgery for the liver and other organs.
Performing The Robotic Prostatectomy: A Prostate Cancer Surgery General Overview For Patients
The essence of minimally invasive prostate cancer surgery is to gain access to the involved anatomy via the smallest entry points possible. Traditional open prostatectomies involved cutting open the lower abdomen with a large incision. Predictably, large incisions in traditional surgery for prostate cancer run a higher risk of infection and require significantly more time for the patient to heal, not to mention they tend to leave a large scar. Laparoscopic techniques however, using the da Vinci Robot, bypass this large incision and gain the same access through a few small holes in the skin, each roughly the size of a dime. A small plastic tube known as a “port” is inserted in each hole to keep a channel open for laparoscopic Port Placement image tools to reach through. To allow room inside for the surgeon to work, the abdomen is inflated slightly with carbon dioxide like a balloon. In this working space, the surgeon can perform the same surgeries as if the abdomen had actually been cut open, but without the large incision.
Risks Of Prostate Surgery
The risks with any type of radical prostatectomy are much like those of any major surgery. Problems during or shortly after the operation can include:
- Reactions to anesthesia
- Blood clots in the legs or lungs
- Damage to nearby organs
- Infections at the surgery site.
Rarely, part of the intestine might be injured during surgery, which could lead to infections in the abdomen and might require more surgery to fix. Injuries to the intestines are more common with laparoscopic and robotic surgeries than with the open approach.
If lymph nodes are removed, a collection of lymph fluid can form and may need to be drained.
In extremely rare cases, a man can die because of complications of this operation. Your risk depends, in part, on your overall health, your age, and the skill of your surgical team.
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After Prostatectomy: What To Expect
At the hospital : You should expect to be in the hospital for one night. At Johns Hopkins, all rooms on the urology floor are private. Here, nurses help patients get moving shortly after surgery to prevent blood clots and other postoperative risks.
First few days at home : After youre sent home, you might find that regular ibuprofen or acetaminophen will be sufficient pain management for the first few days. If over-the-counter medications arent enough, your doctor can help you with alternatives.
One week after surgery : After your surgery site heals, your catheter will be removed. This is usually seven to 10 days after surgery. This can easily be done at your doctors office. Some people decide to take out their catheter at home. If thats the case, ask your doctor for instructions first.
This is also about the time your surgeon will call you with the final pathology results. He or she will discuss what you should know and whether further treatment is necessary.
One month after surgery : Doctors recommend no strenuous activity or heavy lifting for at least one month after surgery. Most people take off work for three to four weeks. If you work from home, you could return to work sooner.
- Urinary incontinence
- Erectile dysfunction
Recovery from surgery takes time. These side effects are often temporary. However, if they are affecting your quality of life, ask your doctor about options that can help.
What Are The Advantages Of This Procedure Compared To Conventional Techniques Such As Open Surgery
Open surgery for radical or total prostatectomy requires, at a minimum, a 20-centimeter incision in the patients abdomen, whereas with laparoscopy, only four to five incision points less than two centimeters are needed. This makes the procedure have a better recovery rate, with minimal complications and leaving an almost imperceptible scar.
- Minimal blood loss .
- Hospital stay no longer than two days and the patient can return home, all this depends on the speed of improvement of the patient and how big was his surgery.
- Shorter recovery time.
- Less postoperative pain and risk of infection.
- Less need to take strong pain relievers or non-steroidal anti-inflammatory drugs . Mild pain can be treated with acetaminophen .
- Quick procedure. It does not usually exceed two or three hours in the operating room.
- 90% of patients have a faster return to daily activities and to work .
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Laparoscopic And Robotic Prostatectomy
Laparoscopic radical prostatectomy and robotic prostatectomy are two surgeries for prostate cancer treatment. The two are similar, but robotic surgery is performed with a machine that is controlled by a surgeon and laparoscopic surgery is performed by the surgeon. Patients who want to opt for one of these procedures should look for surgeons who are experienced in a specific technique. Whether a surgeon performs well either manually or robotically depends mainly on experience.
The laparoscopic and robotic prostatectomies are performed using one of two approaches: extraperitoneal and transperitoneal. The peritoneum is a thin membrane that covers the abdominal cavity. The extraperitoneal prostatectomy does not cut through this membrane, while the transperitoneal prostatectomy does. Some doctors cite shorter recovery times and fewer complications for patients who have undergone the extraperitoneal prostatectomy.
Incision Of The Dorsal Venous Complex And Urethra
This is the final step of the dissection. Using a 0° lens with 1:3 scaling, the dorsal venous complex is incised tangentially to the prostate to avoid capsular incision. A plane between the urethra and dorsal venous complex is gently developed to expose the anterior urethral wall. The Foley catheter is reinserted and used to identify the anterior surface of the urethra at the urethroprostatic junction. The anterior wall of the urethra is transected with the scissors a few millimeters distal to the apex of the prostate .
The posterior wall of the urethra and the rectourethralis muscle are cut under direct vision. The freed specimen is then examined for adequacy of resection margins and is placed in a specimen-retrieval bag.
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Are There Any Risks/side Effects/complications Associated With A Robotic
As with any medical procedure, it is possible for risks or complications to arise. It is best that you speak with your urologist or surgeon about how best to avoid any adverse reactions.
There are some common side effects that can occur after robotic-assisted prostatectomy and these side effects are common to all radical prostate cancer therapies.
These include issues with urinary control and problems with sexual function . Evidence suggests that these problems are less if the robotic-assisted laparoscopic prostatectomy is performed by a high volume surgeon. Your surgeon will be able to discuss these issues in more detail.
Indications And Contraindications For Minimally Invasive Radical Prostatectomy
Candidates for either laparoscopic or robotic radical prostatectomy include patients in whom the diagnosis and staging support organ-confined prostate cancer and in whom the appropriate metastatic workup results are negative. However, both approaches are contraindicated in individuals who have undergone previous pelvic surgery. Prior benign prostatic hyperplasia surgery, along with large prostate size, pose technical challenges and increase operative times and blood loss during robotic radical prostatectomy.
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How Long Does This Surgery Take
Although this surgery takes approximately 3 hours to perform, patients generally feel much better and have significantly fewer pain requirements in the early operative period. Unlike open surgery where the catheter stays in for two to three weeks, most laparoscopic prostatectomy patients have their Foley catheters removed on the third day after surgery.
Side Effects Of Prostate Surgery
The major possible side effects of radical prostatectomy are urinary incontinence and erectile dysfunction . These side effects can also occur with other forms of prostate cancer treatment.
Urinary incontinence: You may not be able to control your urine or you may have leakage or dribbling. Being incontinent can affect you not only physically but emotionally and socially as well. These are the major types of incontinence:
- Men with stress incontinence might leak urine when they cough, laugh, sneeze, or exercise. Stress incontinence is the most common type after prostate surgery. It’s usually caused by problems with the valve that keeps urine in the bladder . Prostate cancer treatments can damage this valve or the nerves that keep the valve working.
- Men with overflow incontinence have trouble emptying their bladder. They take a long time to urinate and have a dribbling stream with little force. Overflow incontinence is usually caused by blockage or narrowing of the bladder outlet by scar tissue.
- Men with urge incontinencehave a sudden need to urinate. This happens when the bladder becomes too sensitive to stretching as it fills with urine.
- Rarely after surgery, men lose all ability to control their urine. This is called continuous incontinence.
After surgery for prostate cancer, normal bladder control usually returns within several weeks or months. This recovery usually occurs slowly over time.
There are several options for treating erectile dysfunction:
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Is Robotic Prostate Surgery Better
traditional prostate surgery has a clear winner. With robotic surgery, patients have a shorter hospital stay and recover more quickly. Doctors have a better chance of not leaving behind parts of a malignant tumor. And this type of surgery is actually easier to master than the traditional open variety.
What Happens After Laparoscopic Prostatectomy
After surgery, you will be hospitalized for approximately two to three days so that doctors can monitor your recovery process and ensure no complications occur after surgery.
Your diet will consist of fluids shortly after the procedure and after youre cleared by your doctor, you may begin to eat regularly again.
You will be encouraged to walk soon after your surgery. This helps prevent complications and helps the healing process by circulating blood in your body.
After you are discharged from Cleveland Clinic, it is normal to feel tired for several weeks after the procedure. It is important however to keep doing light exercise such as walking to continue the healing process.
Any heavy lifting should be avoided for at least three weeks after surgery to avoid injury.
The most important thing is to take it easy and to return to normal activities on a timeline that feels right for you.
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Robotic Laparoscopic Urological Surgery
At Yorktowne Urology we have highly experienced and trained Robotic Laparoscopic surgeons. Our surgeons will diagnose, and treat a wide range of urologic conditions. Here are some diseases or disorders that affects the male reproductive organs or the male and female urinary tract . Some common urologic conditions may include:
- Prostate Cancer
- Urinary Blockage
What Is A Radical Prostatectomy
Surgery to remove the prostate is called a radical prostatectomy. Before the operation, the surgeon will explain what will happen and tell you about the possible side effects. They may also tell you about other treatments that may help in your situation, such as radiotherapy.
The aim of the surgery is to remove all of the cancer cells. It is usually only done when the cancer is contained within the prostate and has not spread to the surrounding area.
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What Are The Advantages Of This Procedure
Traditional surgery for tumor removal requires an eight-inch incision, at a minimum. The minimally invasive technique requires four or five tiny incisions for the surgical instruments. Laparoscopic prostatectomy offers surgeons unparalleled visualization of the pelvic area, thus permitting precise removal of the prostate. Patients also experience significantly less blood loss.
- Additionally, patients benefit from:
- Reduced hospital stay and faster healing
- Less postoperative pain
- Quicker return to normal activity and work
- Smaller incisions and less scarring
Immediately After A Prostatectomy
- You will stay in hospital for two to five days.
- Nurses will monitor your vital signs.
- Your pain will be managed with medication.
- You may be given antibiotics to reduce the risk of infection.
- You may have a drip inserted into your arm or hand for a few days.
- You will most likely have a drain tube out of your abdomen that will be removed in the first day or two after the surgery.
- You will be fitted with a small tube in your penis. The catheter drains urine into an attached bottle or bag. This catheter will be removed about one to three weeks after the operation. Your surgeon will tell you when it can be removed.
- In most cases, you will have to go home still wearing the catheter. You will be taught how to care for it.
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Heres What You Should Know About Laparoscopic Prostate Cancer Surgery
Laparoscopy refers to the abdominal procedure involving imaging technology, often using a scope or a unique camera. Surgery is then performed with the aid of such imaging devices. The procedure is minimally invasive without having to dissect through numerous organs of the body.
There doesnt have to be any large incisions made, which could potentially require long periods of healing time. For prostate cancer surgery cases, laparoscopy has several advantages that favor the patient, which will be discussed below .
Equipment For Robotic Radical Prostatectomy
Currently, the only available integrated robotic surgical system is the da Vinci Surgical System . This computer-aided system has a basic master-slave design. A second generation of this system is currently available .
The surgeon console
This is the user interface of the robot for the surgeon and consists of the following:
Display system: The system is a 3-D stereoscopic display for the console surgeon and is generally available for view in 2-D form by assistants and observers.
Master arms: These are the controls the surgeon uses for making surgical movements. Movements of the master arms translate to real-time movements of the instrument tips and may be scaled for fine movements. The master arms also provide basic force feedback to the surgeon but are limited in their ability to discriminate complex haptic feedback. Camera movements are controlled with a clutch mechanism. In the 4-arm systems, the surgeon can toggle between instruments.
Control panel: The control panel is used to adjust the surgeon console display and control options. The control panel allows toggling between 2- and 3-D display, adjusting various levels of scaling, and choosing the camera perspectives .
Central processing unit: This is the computer that controls the system and integrates and translates robot control inputs from the surgeon.
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Advantages And Disadvantages Of Laparoscopic Transperitoneal Approach
The advantages of the transperitoneal approach include familiarity with anatomy, adequate space for dissection, and the presence of several reference points to aid the surgeon in orientation. Maximum mobility of the bladder is achieved in this approach, which helps provide a tension-free urethrovesical anastomosis.
Disadvantages of the transperitoneal approach include communication of the anastomotic site to the peritoneal cavity with the potential for peritoneal urine leak and ascites. The transperitoneal approach also increases the risk of bowel injury, ileus, and adhesions.
Am I Going To Leak After A Laparoscopic Prostatectomy
For the first few weeks, its recommended to wear a protective pad. The return of continence is fast and, within a few weeks, over 95 percent of patients have full control of their urination. Occasionally I see patients with mild stress urinary incontinence after surgery which usually resolves by performing Kegel exercises.
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What Are The Side Effects
Medical research shows that symptoms of incontinence and impotence are similar for both minimally invasive surgery and traditional surgery. Men usually return to normal urinary function within 3 months.
Because this technique is nerve-sparing, a man’s postoperative ability to have an erection should be comparable to that of traditional surgery. Recent studies have shown no difference between laparoscopic surgery and open surgery called open radical prostatecomy .
Equipment For Laparoscopic Radical Prostatectomy
The laparoscopic approach involves 2-dimensional monitors and conventional laparoscopic instruments with a 10-mm 0° and/or 30° telescope. The camera may be operated by a one-armed camera holder or by an assistant. The use of a single voice-operated robotic arm has also been described as an adjunct to the laparoscopic approach. A camera-holding device provides stability and prevents camera shake that can result from holding it by hand .
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Patient Positioning And Abdominal Access
Regardless of the technique used, the patient is placed in the supine position with the head down. This head-down position allows for gravity to facilitate the natural retraction of the pelvic tissues. If the procedure is to be performed transperitoneally, a periumbilical incision is made to provide access for the initial laparoscopic port. A Veress needle or Hasson-type trocar is used to establish pneumoperitoneum and to facilitate the laparoscopic survey of the abdomen. The Veress needle is an ideal access device when the patient has no history of abdominal surgery. In patients who have undergone previous abdominal surgery, particularly involving infraumbilical incisions, the Hassan trocar is ideal for direct visualization and confirmation of entrance into the peritoneal cavity.
Carbon dioxide is then insufflated into the abdomen to achieve pneumoperitoneum. If a Veress needle was used for initial access, it is replaced by a 12-mm radially dilating laparoscopic trocar. The 3-dimensional robotic laparoscope is then inserted through the infraumbilical trocar site, and a laparoscopic survey of the abdomen and pelvis is performed. If the procedure is to be performed extraperitoneally, the first steps for access consist of a small incision and development of the extraperitoneal space.