Robotic Prostatectomy Surgery in Delhi, India

Robotic prostatectomy may be recommended for patients with prostate cancer who are in the early stages of the disease and have the chance of a complete cure. It may also be recommended for patients in whom other treatments failed, such as radiation therapy, and cancer has come back in the prostate.

Robotic prostatectomy offers several advantages over traditional open surgery, including smaller incisions, less blood loss, and a shorter hospital stay. It also provides the surgeon with greater precision and dexterity, allowing for more precise removal of the prostate gland and reduced damage to surrounding tissues. This allows the surgeon to even be able to save the nerves responsible for the erection of the penis, which travel very close to the prostate. As a result, patients may experience less pain and have a faster recovery compared to traditional surgery, and have better functional outcomes in terms of return of urinary continence and penile erections.

The robotic prostatectomy is a recommended option for treating prostate cancer, especially if it is in the early stages. The goal of the surgery is to remove all the cancer cells by removing the whole of the prostate gland. The best candidates for this surgery should be:

• Patients with localised prostate cancer
• Have a life expectancy exceeding ten years
• Early-stage of cancer
• No prior major surgeries
• Lower BMI
• Healthy personal 
• Have discussed all other treatments options with the doctors

The following conditions make an individual not a good candidate for robotic surgery: 

• Low-grade cancer suitable for active surveillance
• Patients with closed-angle Glaucoma
• Had several prior abdominal surgeries
• Weak immune system
• Heart diseases

The doctor will provide all the necessary details and instructions about the robotic radical prostatectomy surgery . In addition, the doctor may modify the diet, help prepare bowel movements, and give medications or supplements before the surgery. The doctor may also ask to quit smoking before the surgery as it delays the healing process and may also increase the risk of any complication post-surgery.

The doctor may also prescribe some tests like ultrasound, MRI, digital rectal exam, and prostate-specific antigen test to confirm the stage and grade of the prostate cancer. Apart from this, certain preparation needs to be done before a robotic radical prostatectomy surgery. These include:

• Medical evaluation: The doctor will perform certain lab tests and the diagnosis mentioned above to get the exact information about prostate cancer or any other conditions affecting the prostate gland.
• Anti-inflammatory drugs: One has to stop taking any anti-inflammatory medications before the surgery as it may increase the risk of complications during the surgical process.
• Blood-thinning medications: The doctor will stop the blood-thinning drugs and nonprescription pain relievers at least two weeks before the surgery to reduce the risk of bleeding.
• Diet: The doctor will ask you not to eat or drink anything after midnight of the surgery. One can take clear liquid till 4 hours before the surgical procedure.
• Bowel movements: The medical team may give a kit and instructions for clearing the bowels before the surgery.
• Pre-arranging a ride home after the surgery

Before the robotic prostatectomy surgery, the doctor will give general anaesthesia, meaning that one will not be awake during the procedure. The surgery is usually done with in-patient hospitalisation, which means one has to stay for some days in the hospital.

The robotic prostatectomy surgery begins with the surgeon making five small incisions in the lower abdomen. The surgeon then inserts the robotic arms and camera through the incisions using the specialised control panel. The three-dimensional endoscope provides a magnified view (up to 12x zoom) of the structures that surround the prostate gland. The surgeon uses the console to control the robotic arms with precise movement controls. The prostate gland is cut and removed through one of the incisions. The surgeon performs intracorporeal suturing to minimise the risk of any complications.

The surgery usually takes two to three hours to complete. Once done, the patient will be guided to the recovery room. The medical team monitors the condition and helps recover from post-surgery pain and complications.

In addition to the risks associated with the surgery itself, there are also certain side effects that patients may experience following robotic prostatectomy. The most common side effects include:

• Urinary incontinence
• Erectile dysfunction
• Fatigue
• Pain
• Swelling

Please note that not all patients will experience these side effects, and they may be temporary or long-lasting.

Robotic prostatectomy is major surgery, and just like any other surgery, it also comes with some risk of developing complications. Some common complications may include reactions to anaesthesia, bleeding, or infection. Some of the common complications from robotic prostatectomy include:

• Incisional hernia
• Erectile dysfunction
• Urinary incontinence
• Bleeding from the incision site
• Infection
• Swelling around the incision
• Nausea
• Scrotal or penile swelling and bruising
• Perineal discomfort
• Bladder spasms
• Bloating

After the robotic prostatectomy surgery, patients may need to stay in the hospital for one or two days. During the stay in the hospital, the patients are expected to walk the next day of the surgery to ensure a speedy recovery.

The medical team may also provide instructions for some breathing exercises to expand the lungs and prevent infections. The urinary catheter will be in place when the patient leaves the hospital.

However, it will be removed at the next follow-up visit, which is usually after ten days. The recovery period of the robotic prostatectomy is usually four to six weeks. The doctor will also provide a detailed post-operative care package that will help in a speedy recovery. These may include:

• Avoid heavy physical activities like jogging, heavy lifting, and more for at least four weeks.
• Take proper rest
• Take all the medications on time as prescribed by the doctor
• Don't drive for four weeks
• Maintain a healthy lifestyle
• Maintain appropriate wound care to avoid any risk of developing an infection.
• Wear loose and comfortable clothes
• Eat a good diet as advised by the medical team
• Avoid sexual activities for a minimum of four to six weeks

The success rate of robotic prostatectomy is high. The surgery has a low risk of complications and a high success rate in removing cancerous tissue. Patients may experience some side effects after surgery, such as incontinence and impotence. However, these side effects are usually temporary and can be managed with medication or therapy.

Patients who undergo a robotic prostatectomy will need to have follow-up appointments with their surgeon to monitor their recovery. The surgeon usually follows up with a PSA test to ensure that cancer has not returned. Patients may also need to undergo additional treatments, such as radiation therapy if cancer recurs.

The prognosis for patients who undergo a robotic prostatectomy is very good. The surgery has a high success rate, and most of the patients recover completely and are cancer free. A small proportion of patients who have the high-grade disease may require adjuvant therapy following surgery.

Patients who experience complications or side effects after a robotic prostatectomy should consult their doctor immediately. Complications may include bleeding, infection or difficulty urinating. Side effects may include incontinence, impotence, or fatigue. Patients should also contact their doctor if they notice any signs of cancer recurrence, such as blood in the urine or difficulty urinating.

1. The success rate of robotic prostatectomy

Robotic prostatectomy is a minimally invasive surgery that is used to remove the prostate gland. The success rate of robotic prostatectomy depends on several factors, such as the experience of the surgeon, the stage of cancer, and the patient's overall health. According to a study, the success rate of robotic prostatectomy in terms of cancer control is about 90-95%. However, the success rate may vary depending on individual circumstances.

2. Advantages of robotic prostatectomy

Robotic prostatectomy is considered better than traditional open surgery due to several advantages. These include smaller incisions, less blood loss, reduced pain and discomfort, faster recovery, and shorter hospital stays. The robotic technology used in the surgery allows the surgeon to have better visualisation and precision, leading to improved outcomes.

3. Hospital stay for robotic prostatectomy

The length of hospital stay for a robotic prostatectomy is usually 2-3 days, depending on individual circumstances. However, patients may need to stay longer if there are any complications or if they require additional monitoring.

4. Pain after robotic prostatectomy

Pain after a robotic prostatectomy is typically mild to moderate and can be managed with pain medications. Patients may experience discomfort around the incision sites and may also have some urinary discomfort. However, most patients are able to manage their pain with medications, and the discomfort usually subsides within a week's time.

5. Exercise after robotic prostatectomy

Patients are typically advised to avoid any strenuous activity or exercise for at least 4-6 weeks after robotic prostatectomy. This allows the body to heal and reduces the risk of complications. Patients should also avoid heavy lifting and any activity that puts pressure on the surgical site.

6. Role of new robotic technology in radical prostatectomy

New robotic technology has greatly assisted surgeons in performing radical prostatectomy. The technology allows for better visualisation and precision during the surgery, which leads to improved outcomes. Surgeons are able to perform the surgery with smaller incisions, resulting in less blood loss, reduced pain, and faster recovery.

7. Recovery after prostate surgery

Recovery after prostate surgery can take several weeks to months. Patients may experience some discomfort and fatigue during the recovery period and may need to take time off from work. Patients may also experience some urinary incontinence and sexual dysfunction, which can improve over time with the help of rehabilitation exercises.

8. Cost of robotic prostatectomy surgery

The cost of robotic prostatectomy surgery varies depending on several factors, such as the hospital, surgeon's fee, and insurance coverage. Patients are advised to check with their insurance provider to see if the procedure is covered.

9. Robotic surgery vs traditional surgery for prostate removal

Robotic surgery is considered better than traditional open surgery for prostate removal due to several advantages. These include smaller incisions, less blood loss, reduced pain and discomfort, faster recovery, and shorter hospital stays. The robotic technology used in the surgery allows the surgeon to have better visualisation and precision, leading to improved outcomes. Robotic surgery has now become the gold standard for treating prostate cancer and has replaced open surgery at almost all centres.

Reviewed by Dr. Tushar Aditya Narain, Senior Consultant, Robotic Surgery, Uro-Oncology, Cancer Care / Oncology, Surgical Oncology on 23-Mar-2023.

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