Robotic-assisted laparoscopic prostatectomy: Kent and Canterbury Hospital

Information for patients from the Urology Department

This leaflet has been produced to explain robotic-assisted radical prostatectomy, as a surgical treatment for prostate cancer. This information supports your consultant and specialist nurse consultations. For more information on the procedure and what will happen when you arrive at hospital, please go to the Prostate Forum web page www.ekhuft.nhs.uk/robotic-prostatectomy/

What is robotic prostatectomy?

Prostatectomy is the surgical removal of the prostate gland as a treatment for prostate cancer. To do this we now use a surgical robot called the Da Vinci® which enables us to do difficult laparoscopic or keyhole surgery, as opposed to the traditional open surgery. The surgery is performed under a general anaesthetic (you are asleep for the procedure).

Surgeon using the da Vinci® robot
Da Vinci® surgical robot

The robot is controlled by the surgeon at all times and does not work on its own. The robot is connected to the patient and very small instruments are inserted through small surgical incisions (cuts) in the patient’s abdominal wall. The surgeon sits at a separate console and carries out the operation without touching the patient. The surgeon has complete control of the robot at all times.

Kent and Canterbury Hospital was the first hospital in the South East of England, outside of London, to offer this advanced treatment option.

We are a robotic training centre

We are a national training centre in robotic surgery, and run an international fellowship training programme. The fellow works under the supervision of consultants at all times, and may perform part or all of your surgery.

Is the surgeon able to do the same operation as an open prostatectomy with the robot?

Yes. In terms of cancer treatment it is regarded as the same as open surgery and does not compromise cancer control.

What are the advantages of robotic surgery?

This type of surgery offers many advantages for both you and your surgeon.

Diagram showing a surgical cut from the navel (belly button) downwards to groin, compared to the five small incisions made by da Vinci® on the abdomen
Comparison between incisions made surgically and those made by da Vinci®

Surgical advantages

Patient advantages

Are there any alternatives to this treatment?

Yes. You should have discussed these with your urologist or oncologist. Depending on your age, PSA blood test, type of disease, and other health issues, radiotherapy, brachytherapy, surveillance, or hormone therapy are all treatment options. However this type of surgery is only chosen if we feel it is the most appropriate treatment option for you, and you are happy to proceed.

Are there any complications to having this surgery?

Yes. All surgery has the potential for complications, however robotic surgery minimises these risks. These should be discussed with you by your surgeon before signing the consent form.

Short-term common risks

Short-term rare complications

Removal of lymph nodes

In selected patients with higher grade or higher volume disease, removal of the lymph nodes within the pelvis may be discussed with you. The reason for this is to find out if there has been spread of the prostate cancer to these lymph nodes that is not detectable on scans.

Most patients will not notice any side effects from the removal of the nodes. A small number of patients may have complications related to this part of their operation. These include:

Most of the above problems would be identified by your medical team before your discharge from hospital or at your follow-up appointments.

If you are at all concerned, please use the contact numbers listed either on page 10 of this leaflet or on your discharge leaflet. One of our specialist nurses will also contact you by phone following your discharge from hospital; you can raise any concerns you have with them.

Long-term complications

Time since surgery % of patients that are pad free
one week 29 to 30%
six weeks 45 to 50%
12 weeks 65 to 75%
26 weeks 75 to 85%
52 weeks 90 to 95%

Will I lose my desire / libido after surgery?

No. The operation should not affect your libido. It will affect your fertility though. You will have no ejaculate following your operation and in some men they notice a small degree of penile shortening.

When can I start sexual relations?

There is no restriction on resuming sexual relations after the catheter is removed, once you and your partner are happy to do so.

Can the robot breakdown?

Potentially, although this very rarely happens (less than one in every 200 operations). If this happens either your operation can be rescheduled or it can be done as an open operation. Over 4000 robots are being used worldwide and this has only been reported in a handful of cases. We have had to cancel operations on the day of surgery due to equipment failure when testing before surgery, but then rebooked patients onto the next available surgical list.

What happens now?

Once we have decided on robotic surgery:

How can I prepare for my surgery?

While you wait for your surgery date, you can start preparing for your operation. Research shows that fitter patients, who are able to improve their health and activity levels before surgery, recover more quickly. Taking an active role in planning and preparing for your operation will help you:

To help with this, you may be contacted by a member of the One You Kent (OYK) team. OYK work in the community, and help patients improve their general health. This includes help and advice on:

More information can be found on the following web sites.

How long does the operation take?

The operation takes two to three hours. It is done under general anaesthetic (you are asleep for the operation). You will wake up in the recovery bay before being transferred back to the ward.

Will I be in pain?

Robotic surgery is less painful than open surgery. Before you wake up the anaesthetist will give you pain relief and we use local anaesthetic (numbing solution) in your wounds and bladder. If you are in pain, please tell the nursing staff so they can give you pain relief.

A lot of patients wake up feeling as though they have a full bladder or get bladder spasms, this is because of the catheter and the surgery around your bladder, not because your bladder is full. This usually settles but if not can be helped with medication.

The anaesthetist may consider giving you a spinal injection before your surgery, to help control any pain afterwards.

How long will I be in hospital?

One day. The majority of patients are discharged the day after their operation. Along with the catheter, you will wake up with a drain tube which is removed before your discharge from hospital. You will also be taught how to give yourself a small injection each day for four weeks, to help prevent clots forming in the veins in your legs.

How can I help prevent blood clots (DVT or deep vein thrombosis)?

To prevent clots you will be taught how to give yourself an injection in to your stomach; you will need do this each day for 28 days after your surgery. You will be taught how to do this on the ward before you leave hospital.

You will also be given surgical stockings to wear for a time after surgery.

Will I have help after I am discharged from hospital?

Yes.

See useful contact numbers at the end of this leaflet.

How do I look after myself at home?

How long will I need a catheter for?

The catheter is a very important part of your recovery. It protects the join between your bladder and your urethra (water pipe) in the early stages of healing. We like to leave the catheter in place for as short a time as possible, between seven to 10 days after your operation.

Removal of the catheter is very straight forward and only takes a matter of seconds; this is done in the Urology Department. Before you are discharged from hospital you will be given a date for your catheter to be removed. Occasionally your surgeon may make a decision to leave the catheter in for longer, but you would be told of this decision and the reasons why.

Once the catheter is removed, please continue doing your pelvic floor exercises regularly.

Remember that to start with, most patients have some leakage once their catheter is removed and you may need to use pads for a period of time. This is where the Kent Continence Service will help you.

When do I get my results?

It takes our pathologists about two weeks to process and examine your prostate. If you wish to receive your results before your six week follow-up appointment, please ask your prostate specialist nurse when you are contacted after discharge.

Will I need any other treatment?

Most patients do not need any other treatment. However some patients with more advanced disease may be offered radiotherapy either immediately after their surgery, or later if there is a rise in their PSA levels. Others may be given a long course of hormones. Your surgeon will discuss this with you. Further appointments with the oncologists may be needed in this situation.

Will I have follow-up appointments?

After your initial pathology results you will be seen by your surgeon six weeks after your surgery, and then every three months to check your PSA levels. If all is well, then the time between your appointments can be lengthened. You may also have appointments with the physiotherapist to make sure your pelvic floor muscles are recovering. Erectile dysfunction will be discussed at a specialist clinic, if this is important to you.

When can I drive?

This varies between patients. You will only be fit to drive if you can do an emergency stop without it causing pain. Please wait at least one week before driving again.

When can I return to work?

Again this varies between patients. You can return to work when you feel able. Some patients are back to work after one week, others take three to four weeks. It is important to only do light duties to start with and to do no heavy lifting for four weeks.

We have found that after robotic surgery patients return to work quicker, on average at three weeks compared to 11 weeks after open surgery.

When can I fly?

You can fly on short haul flights from two weeks after your surgery, and long haul flights from four weeks. These are recommendations, if you have any concerns please delay your travel. You must also check with your carrier and travel insurance company.

What can we do to improve our service?

We are constantly trying to improve the high quality care we provide. We continually audit and assess our results. We will ask you to fill out questionnaires on your continence, erectile dysfunction, and overall quality of life. We would like you to fill these out before your operation and at all your follow-up appointments. We also want you to record the first day you manage without pads and when you return to work. Please let us know these dates at your follow-up appointment or by email.

All this information is handled sensitively. Please feel free to add any other comments, whether good or bad. All these comments will be taken seriously and will be used to improve the experience for future patients.

Where can I get further information about my operation?

Useful contact numbers