Preparing for Robotic Assisted Laparoscopic Radical Prostatectomy

Prostatectomy refers to the total removal of the prostate gland. This surgery is done when one has been diagnosed with localized Prostate Cancer. 

You will be put under general anaesthesia (GA).  This procedure is performed as a robotic-assisted laparoscopic technique, which entails the 5 small incisions over the abdomen for the introduction of instruments mounted onto a robotic console. The instruments are controlled by the surgeon during the surgery. Benefits of laparoscopic (keyhole) surgery over open surgery include less bleeding, post-operative pain and faster recovery.

The entire prostate gland, together with the attached seminal vesicles (the glands which secrete seminal fluid) and vas deferens (the tube that carries sperm from the testes to urethra) are removed. After removal of the prostate, the bladder neck which normally rests above the prostate is re-joined to the urethra below (urinary passageway draining from the bladder) using stitches to restore normal urine flow. 

The pelvic lymph nodes around the prostate may also be removed, especially in intermediate or high risk cancer profiles. Your cancer risk profile is decided by your urologist after reviewing the results of the prostate blood test, prostate scan results and biopsy outcomes.

After the vas deferens and seminal vesicles are removed, semen will no longer be produced, and therefore, fertilization through the normal route will not be possible.

Your urologist or a member of their team will review your history and medications before the surgery and discuss with you regarding your surgery to confirm your understanding and consent for surgery. The anaesthetist will perform their final assessments before putting you under anaesthesia for the procedure. The operation lasts an average of 4 - 6 hours depending on the complexity. Most patients stay in hospital for 2-3 days on average.

After the surgery, you will be placed under close monitoring to look for any complications of surgery. There will be a urinary catheter (urine tube draining urine from your bladder into a bag) and a drain (a plastic tube to drain fluid out of your body) will be placed around the area where your prostate was removed to prevent excessive fluid accumulation in your body. The drain is temporary and usually removed as soon as you are mobile or when not required anymore. 

Most patients will experience pain over the operative site and the necessary painkillers will be administered to you depending on your level of pain. Some bloatedness (gaseous abdominal distension) is expected and usually temporary. In some cases, you may feel nausea after the surgery which may be a side effect of the anaesthetic drugs given to you during or after the surgery. Hence, most patients are not able to resume their usual diet immediately after surgery and are usually placed on intravenous (IV) drip and given fluids to drink first. Most patients are able to sit out of bed the next day and early movement is encouraged to help with recovery. You will also be prescribed with stool softener for 2 weeks to avoid straining at passing motion. You are also advised to increase your fluid and fibre intake during this period to reduce the risk of constipation 

You will be discharged with the urinary catheter and an appointment will be made to have it removed in clinic about 1 to 2 weeks later. Following the removal of the catheter, you may experience some urinary leakage and require the use of urinary pads. It is important to initiate pelvic floor exercises after catheter removal and perform them regularly to quicken the recovery of continence. 

Suitable patients will start penile rehabilitation to enhance potency recovery. This will entail having to consume tablet medications and usage of vacuum pumps which will be discussed in greater details when you are back for your appointment after surgery.