FAQ - Robotic Urologic Surgery

General Robotic-Assisted Surgery Questions

The da Vinci® Robot Surgical System is one of the most famous robotic surgery apparatuses around the world. Commonly used for prostatectomies, the da Vinci® robot is comprised of 3 parts – a surgeon’s console, a patient-side robotic cart with four arms controlled by the surgeon and a 3D, high-definition camera. This cutting-edge technology enables the surgeon to get closer to the surgical site than the human vision allows.

Consult with your doctor to see if you are eligible for robotic surgery. Most men diagnosed with localized cancer are candidates for robotic surgery.
 

Robotic Prostatectomy and Sexual Rehabilitation

A surgical procedure using the da Vinci® Surgical System to completely remove the prostate gland when cancer is present.

Patients potentially risk infection at the catheter’s exit and incision site as well as excessive bleeding, blood clots, incontinence, impotence, hernia and sterility.

Robotic prostatectomy typically takes about 2 to 3 hours.

General anesthesia is required to keep patients sedated and to prevent pain during the procedure.

No, a blood transfusion is not necessary. The estimated blood loss with robotic prostatectomy is less than 3% of the blood transfusion requirement.

Yes, a catheter is inserted in the urethra and is connected to a drainage bag. During the prostatectomy, the catheter is used to drain the bladder.

The catheter is removed typically within five to seven days following the procedure.

Patients typically spend one night at the hospital and will be discharged the following the day if they are able to tolerate pain via controlled oral medications and have acceptable laboratory results.

Patients should take medications as directed by your doctor while avoiding products with aspirin. Patients are advised to drink plenty of fluids and avoid vigorous exercises for six weeks. Also, the patient should gently wash the incision with mild soap and water. Furthermore, patients should keep their legs elevated when resting in bed and should avoid consuming alcohol, caffeinated drinks and spicy foods.

Patients will experience temporary urinary incontinence. Normal control of urination is regained within 6 to 8 months.

After the removal of the prostate, erectile function is typically lost. While erections may still be regained, there are other factors to consider including age, sexual function prior to and after the operation, concurrent illness, medications as well as emotional and psychological stress.

While the prostate does not affect a male’s ability to have erections, the surrounding nerves that are critical for having an erection may be damaged during prostatectomy.

There are cases in which important nerves for sexual function are removed, resulting in impotence. Erectile function, however, may be restored via nerve graft and reconstruction.

Although the recovery of erectile function varies, patients regain it within one to two years after surgery. In few reported cases, erections may return in as early as 4 weeks spontaneously or with medication.

Reportedly, 84% of men said that erectile function returned to normal about one to two years after prostatectomy. Only 13% of men claimed their erections were weaker.

Prostatectomy does not affect libido. Your sex drive is primarily affected by testosterone.

You can resume physical intimacy as soon as you feel better. This potentially improves your chances of regaining erectile function much earlier. You can have sexual intercourse when erectile function is recovered within one to two years after prostatectomy. Also, there are treatments available for satisfactory sex life including Viagra and penile injection therapy.

During laparoscopic and robotic prostatectomy, nerves associated with sexual function are spared if the cancer has not yet spread. It’s important to keep in mind that satisfactory erectile function is not guaranteed by nerve sparing because it is influenced by a wide range of factors including age, medications as well as emotional and psychological stress.

The fluid in semen is produced by the prostate and seminal vesicles. With radical prostatectomy, the semen’s pathway is removed. As a result, you will experience a dry orgasm that lacks ejaculate.

Orgasm can still occur as long as normal sensation is intact. Because orgasm happens in the brain, you’ll still able to have an orgasm without a prostate.

Since the semen can no longer be ejaculated due to the removal of the semen pathway during radical prostatectomy, you will be sterile. If you’re planning to have children, your sperm cells may be extracted from the testes or epididymis. You may also choose to cryopreserve your sperm before the procedure.

Yes, patients may travel by car or plane in two days after the procedure.

Patients can return to their daily activities within four weeks, however they should avoid vigorous exercises like weightlifting until six weeks after the operation.

 

Robotic Kidney Surgery

Generally, most kidney tumors are cancers whereas smaller tumors are more likely to be benign. Benign kidney tumors should still be removed as they may grow over time.

Traditionally, biopsies are rarely performed for kidney tumors due to risks of bleeding, tumor spread and false diagnosis. With improved technology, emerging evidence suggests that biopsy is safe and accurate. LLUMC offers renal biopsy for select patients. Once the tumor is removed from the body, a pathologist will formally evaluate to determine what kind of tumor it is.

While some kidney cysts are cancerous, most are not. If a kidney cyst appears “complex” on a CT scan, MRI or ultrasound, then it may be cancerous and will need to be removed. Simple cysts usually do not need to be treated.

While some evidence suggests that removing the primary cancer in the kidney can extend the life of patients with metastatic kidney cancer, an evaluation needs to be made to determine how risky the surgery would be. If possible, it may be best to have a minimally invasive removal to limit recovery times.

Most kidney cancers are cured with surgical removal. If the cancer has spread, it may be difficult to cure. X-rays are routinely performed to monitor the spread of cancer.

Traditionally, kidney tumors were removed through open surgeries with painful and large incisions. Today, open surgeries are being replaced by minimally-invasive surgeries using robots and laparoscopes, resulting in smaller incisions, less pain and faster recovery time.

Partial nephrectomy for small tumors preserves part of the patients’ kidney while getting rid of the cancer or tumor. As a result, the patient keeps most of the kidney and often maintains better overall kidney function.

Consider the following questions to ask your surgeon:

  • Can kidney surgery be done robotically? Most kidney tumors removed robotically have the same outcomes as open surgery and results in quicker recovery times and significantly less pain.
  • Can I have a robotic partial nephrectomy instead of total removal or open surgery? LLUMC staff uses robotic assistance to successfully perform partial nephrectomy for even the most complex tumors including tumors situated deep within the kidney and tumors beside crucial vessels that supply blood to the kidney.
  • What formal training do your surgeons have in robotic and laparoscopic surgery? LLUMC’s Robotic and Minimally Invasive Surgeons were the first in the region to utilize robotic technology.

Yes, most urologists are trained in performing open kidney surgery. LLUMC offers robotic, laparoscopic and open surgery for kidney cancer.