da Vinciâ Prostatectomy:
Pre- and Post-Operative Instructions
Patient Selection
Patient selection is essentially the same as for conventional
open radical prostatectomy. In general, the ideal candidates
for the dVP are men who have localized disease (Stages T1 and
T2); PSA levels less than 20 ng/mL and a Gleason score of less
than eight. Finally, the dVP is usually restricted to men who
have a ten-year or more life expectancy and are in sufficient
health to withstand the risks of major surgery.
Pre-Operative Preparation
Routine pre-operative testing is performed which includes:
History and Physical Examination, Electrocardiogram, Chest
X-Ray, Complete Blood Count, Coagulation Profile,
Comprehensive Metabolic Panel, and Urinalysis.
Since the risk of blood loss and transfusion are minimal with
the dVP, autologous blood collection is not required.
A clear liquid diet is started the day prior to surgery.
Patients are instructed to drink one bottle of magnesium
citrate on the evening before surgery and administer a Fleet
enema at home the morning of surgery to help evacuate the
bowel contents.
Patients should receive nothing by mouth for at least six
hours prior to surgery. They are admitted to the hospital on
the day of surgery. Antibiotic prophylaxis is administered and
sequential compression stockings are applied in the
pre-operative holding area.
The Operation
The dVP is performed through 5 to 6 small 1-cm incisions
across the mid abdomen. Through these small incisions, fine
laparoscopic instruments are inserted to dissect the prostate
gland, seminal vesicles, and vasa deferentia from the urethra
and bladder adhering to the same anatomic principals of open
surgery. Excellent visualization of the prostate gland and the
surrounding neurovascular structures is achieved with the use
of a high-powered telescopic lens attached to a camera device.
Once the prostate gland is dissected free from the bladder,
rectum, and urethra, it is placed in a small plastic bag and
eventually removed by extending one of the small 1-cm
incisions to accommodate the prostate. The bladder is sewn
back to the urethra to restore continuity of the urinary
tract. A catheter is placed through the penis to drain the
bladder and allow healing of the bladder-urethra connection.
In addition, a small drain is placed near the surgical site,
exiting one of the small 1-cm incisions.
Potential Risks and Complications
Although proven very safe, the dVP is major surgery, performed
under general anesthesia and carries the potential risks and
complications of any major operation including heart attack,
stroke, and death. In addition, the dVP may be associated with
the risks of impotence and incontinence. Other potential risks
include bleeding, infection, adjacent tissue/organ injury,
urethrovesical anastomotic leakage, port site hernia, and
conversion to open surgery.
What to Expect After the Surgery Hospital Stay: Length of hospital stay for most
patients is 1-2 days.
Post-Operative Pain: Because it is performed through
very small incisions, the dVP is associated with very little
surgical pain. Most patients recover without narcotic
medication, which reduces side effects such as lethargy,
constipation, and dizziness. The reduction of pain also
permits most patients to get on their feet within hours of
surgery and to leave the hospital on the first post-operative
day.
Bladder Spasms: Bladder Spasms are commonly experienced
as a moderate cramping sensation in the lower abdomen or
bladder and are quite common after prostatectomy. These spasms
are usually transient and often decrease over time. If severe,
medications can be prescribed by your doctor to decrease the
episodes of these spasms.
Urinary Catheter: You can expect to have a urinary
catheter (Foley) draining your bladder for approximately 5-7
days after the surgery. It is not uncommon to have
blood-tinged urine for a few days to a week after your
surgery.
Pelvic Drain: The pelvic drain is placed in the
operating room and drains the pelvic space around the
bladder-urethra anastomosis. This drain is usually removed in
24 hours when the drainage is minimal.
Diet: Most patients are able to tolerate clear liquids
a few hours after surgery and a regular diet the following
day. Liberal fluid intake is encouraged.
Fatigue: Generalized fatigue is common and should start
to subside in a few weeks.
Constipation: You may experience sluggish bowels for
several days to a week after surgery. Suppositories and stool
softeners can be used to help with this problem.
Showering: You may shower at home. Your wound sites can
get wet, but must be patted dry. Tub baths can soak your
incisions and therefore are not recommended in the first 2
weeks after surgery. Sutures underneath the skin will dissolve
in 4-6 weeks.
Activity: Walking is strongly advised. Prolonged
sitting or lying in bed should be avoided and can increase
your risk for forming blood clots in the legs as well as
developing pneumonia. Climbing stairs is possible but should
be limited. Driving should be avoided for at least 1 week
after surgery. Most patients return to full activity an
average of 2 weeks after surgery.
Medications: You can resume your usual medications
after surgery with the exception of aspirin or other blood
thinners, which can increase the risk of bleeding.
Follow-up Appointment: You will need to call the office
soon after your discharge to schedule a follow up visit for
5-7 days week after your surgery date for removal of your
Foley catheter. An X-ray test of the bladder and urethra
(called a cystogram) may be required to confirm that the
bladder and urethra are healed prior to removing the Foley
catheter.
Pathology Results: The pathology results are typically
available within 5-7 days after your surgery.
Long-term Follow-up: Depending on the final pathologic
stage of the prostate cancer, a patient may or may not require
additional cancer treatments. In either event the mainstay of
surveillance will consist of periodic measurement of blood
prostate specific antigen (PSA), universally recognized to be
the most sensitive indicator of cancer recurrence. The initial
surveillance PSA test is drawn at 6 weeks following surgery
and then every 6-12 months thereafter.
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