Robotic-assisted laparoscopic prostatectomy (RALP) is used to treat prostate cancer. It is minimally invasive and involves the removal of a man’s prostate gland. Additionally, a surgeon uses a robot to control instruments during a RALP procedure.
Comprehensive Urology offers RALP and other prostate cancer treatments. Our team of expert urologists meets with prostate cancer patients, learns about their symptoms, and helps patients determine whether RALP is a viable treatment option.
In this guide, we’ll take a closer look at RALP, how it works, and its benefits. We’ll also provide an FAQ to teach patients about RALP and help them weigh the pros and cons of robotic-assisted prostate surgery.
What Is RALP?
RALP involves the use of the da Vinci Surgical System, a sophisticated robotic platform. The da Vinci System includes an ergonomic surgeon’s console, patient side cart with four interactive robotic arms, 3D high-definition vision system, and proprietary EndoWrist instruments. It scales, filters, and translates all of a surgeon’s hand movements via EndoWrist instruments. As a result, the da Vinci System enables a surgeon to perform advanced prostate cancer surgery faster and more efficiently than ever before.
In some instances, a RALP procedure feels like an “open” surgery similar to a traditional prostate cancer removal. Yet RALP surgeries are more advanced that most traditional prostate cancer procedures.
The da Vinci System allows a surgeon to magnify a patient’s anatomy like never before. A surgeon can use the da Vinci System to review a patient’s anatomy at a high magnification, in brilliant color, and with natural depth of field. That way, a surgeon can quickly identify and treat prostate cancer tissue.
During a RALP procedure, a surgeon uses the da Vinci System’s master controls to maneuver the four robotic arms on the patient s/yjAGc5lExgside cart; these arms hold EndoWrist instruments and a high-resolution endoscopic camera in place. The EndoWrist instruments feature a distinct jointed-wrist design that surpasses the natural range of motion of the human hand. Therefore, a surgeon can refine the instruments’ movements for unparalleled control and stability.
Furthermore, the da Vinci System boasts a fail-safe design. It includes many safety features to reduce the risk of human error in comparison to other prostate cancer surgery treatments.
Benefits of Robotic Prostate Surgery over Traditional Open Prostate Surgery
Robotic prostate surgery is an FDA-approved and minimally invasive surgery, and it requires only small incisions to treat prostate cancer. Also, the surgery involves the use of a 3D endoscope and high-intensity illuminators that provide a surgeon with high-definition images of a patient’s anatomy; this ensures a surgeon can identify malignant tissue and leave surrounding muscle, tissue, and organs intact.
Other benefits of robotic prostate surgery include:
- Exceptional Accuracy: The da Vinci System has flexible wrists to help a surgeon make slight, careful movements for improved accuracy during prostate cancer surgery.
- Fast Recovery Time: Because robotic prostate surgery requires small incisions, the healing time tends to be quicker in contrast to traditional open prostate surgery.
- Short Hospital Stay: Most robotic prostate surgery patients can leave the hospital and return to their everyday activities more quickly than those who undergo traditional open prostate cancer procedures.
- Reduced Risk of Infection: Robotic prostate surgery often results in less pain and bleeding for patients, as well as reduces a patient’s risk of infection.
- Improved Urine Control and Sexual Function: Studies show prostate cancer patients who undergo a RALP procedure recover from urinary continence and erections at superior rates relative to patients who receive traditional laparoscopic or open surgeries.
There is no guarantee that a prostate cancer patient is eligible to receive robotic prostate cancer surgery. And in some instances, traditional open prostate surgery may prove to be ideal.
To determine whether a patient should undergo robotic prostate cancer surgery or a traditional open retropubic radical prostatectomy treatment, it is important to consult with an expert urologist. During a urological consultation, a patient will receive a full medical assessment, and a urologist will learn about this individual’s prostate cancer symptoms. Then, a urologist can offer a proper diagnosis and determine whether a patient is a viable candidate for robotic prostate surgery.
Robotic Assisted Laparoscopic Prostatectomy vs Conventional Laparoscopic Prostatectomy
The da Vinci System generally proves to be a top alternative to conventional laparoscopy too. A conventional laparoscopy requires a surgeon to stand while operating and use handheld, long-shafted instruments on his or her own. Meanwhile, a conventional laparoscopy involves the use of a 2D monitor to view a patient’s anatomy; this monitor is typically placed a few feet away from a surgeon, and he or she must look up and away from instruments to view it. A conventional laparoscopy usually requires a surgeon and a patient-side assistant to work closely to position the camera correctly as well. Because if the camera is out of position, the surgery may fail to provide a patient with his or her desired results.
RALP Surgery Process
RALP surgery involves the following steps:
Step 1: Robotic Port and Instrument Setup
The da Vinci System is docked, and the robotic instrument ports and camera port are attached to the system’s arms. This step requires about 10 to 15 minutes to complete.
Step 2: Bladder Release
The surgeon controls the da Vinci System instruments and uses robotic “scissors” in one hand and a grasper in the other to cauterize tissues and cut them with the scissors. He or she slowly “mobilizes” the bladder and separates it from the abdominal wall. This allows the surgeon to visualize and reach the prostate gland.
Step 3: Prostate Dissection
The surgeon carefully frees the prostate gland from tissues, and he or she uses a medical “stapler” device to divide and seal prostate gland tissues and blood vessels.
Step 4: Separation of Prostate and Bladder
The surgeon cuts and cauterizes the prostate away from the bladder until he or she reaches the urethra, which is separated to free the prostate from the bladder.
Step 5: Separation of Prostate from Remainder of Urethra
The surgeon releases the prostate from the remainder of the urethra, and the urethra will later be reattached to the bladder. It is critical for the surgeon to preserve the urethra tissue to ensure a complete “repair” when he or she sews the urethra back to the bladder.
Step 6: “Bagging” of Prostate
The surgeon places the prostate gland in a specimen bag that is inserted through a da Vinci System assistant port. The bag is deployed, and once the prostate is inside the bag, this bag can be closed by pulling its strings. The bag stays inside the abdomen until the surgery is complete and the da Vinci System is moved away from the patient.
Step 7: Attachment of Cut-End of Urethra to Bladder
The surgeon uses sutures to perform anastomosis, an attachment process that involves sewing the bladder neck and suturing it to the urethra in one spot. The surgeon ensures tissues are connected correctly to minimize the risk of urine leakage and scar tissue.
Following RALP, a surgeon will insert a special catheter that will remain in place for about a week. A patient should also expect surgical sutures to dissolve on their own shortly after treatment.
Am I a Good Candidate for Robotic Prostate Surgery?
Each prostate cancer patient is different, and even though robotic prostate surgery is the right choice for some patients, it may not be the best treatment option for others.
A urologist evaluates potential RALP surgery candidates based on a variety of criteria, including:
- Patient’s age and life expectancy
- Patient’s size
- Physical condition
- Surgical history
A urologist always allocates time and resources to teach each patient about RALP surgery and determine whether an individual can reap the benefits of this procedure. If the risks associated with a RALP procedure outweigh its benefits, a urologist will recommend alternative prostate cancer treatment options.
What Types of Robotic-Assisted Prostate Surgery Options Are Available?
The da Vinci System is used to perform two prostate cancer procedures:
1. Robotic-Assisted Laparoscopic Radical Prostatectomy
Robotic-assisted laparoscopic radical prostatectomy requires only five stitches, and each stitch is no larger than 1.5 cm in size. It allows a surgeon to dissect and remove the prostate and sew the bladder to the urethra – all without requiring the surgeon to place his or her hands inside of a patient’s body. Depending on a patient’s condition, robotic-assisted laparoscopic radical prostatectomy may be used to remove a patient’s lymph nodes as well.
2. Robotic-Assisted Surgery for Benign Prostatic Hypertrophy (BPH)
BPH refers to an enlarged prostate. When the prostate grows, it begins to squeeze down on the urethra, and the bladder wall becomes thicker. This causes the bladder to weaken and lose the ability to empty completely.
Robotic-assisted surgery has been shown to help prostate cancer patients address BPH. A surgeon uses the procedure to remove portions of an enlarged prostate via the da Vinci System. First, a surgeon determines incision placement based on the size of the prostate and evaluates a patient’s symptoms and overall health. He or she next uses the da Vinci System to make precise incisions to remove enlarged portions of the prostate and sew the prostate gland back together. Best of all, surgeons often use the da Vinci System to ensure the urethra is untouched throughout the procedure.
A urologist is happy to teach patients about both types of robotic-assisted prostate surgeries. He or she will explain how each surgery is performed, along with what patients should do to prepare for surgery and what patients should expect during each treatment recovery period.
How Should Patients Prepare for RALP Surgery?
Sometimes, patients will need to stop taking daily medications prior to surgery, but patients can resume taking these medications immediately after surgery. A urologist will let a patient know whether it is safe to continue with daily medications leading up to surgery, and patients should always disclose all medications to a urologist prior to treatment.
A urologist performs a preoperative bowel preparation on a patient prior to RALP surgery. This includes both antibiotic and mechanical bowel cleansing and reduces the potential for infection.
On the day of surgery, a preoperative enema is administered to a patient. This individual also receives sequential compression stockings, and a large-bore intravenous line is inserted that provides preoperative antibiotics.
What Should Patients Expect During Recovery from Robotic-Assisted Prostatectomy?
Recovery from robotic-assisted prostate surgery is short in comparison to conventional prostate cancer treatments. Robotic-assisted prostate surgery patients often spend one to two days in the hospital before they return home after surgery; comparatively, a traditional prostate cancer surgery patient may require a week or more in the hospital following treatment.
After robotic-assisted prostate surgery, a patient should expect some pain and swelling. These symptoms generally disappear on their own. The symptoms can also be managed with rest, or a patient may be prescribed pain medication.
Once a robotic-assisted prostate surgery patient can retain liquids and obtains acceptable laboratory tests, this individual will receive authorization to return home from the hospital. Patients are discharged with a special catheter that is held in place by a balloon inside the bladder. The catheter provides continuous drainage of the bladder into a small external collection bag, and this bag will need to be emptied periodically. A patient should not remove the catheter bag; instead, a patient requires an outpatient visit approximately five to seven days after surgery to ensure proper removal by a urologist. If a catheter comes out before a follow-up appointment, a patient should contact a urologist immediately.
Physical Activity After RALP
Patients should avoid vigorous activity like golfing, running, or exercising for at least one week after RALP surgery, and they should refrain from driving and sitting in one position for too long (45 minutes or longer). Patients should also avoid bathtubs, swimming pools, and hot tubs for as long as the catheter is in place; conversely, patients can shower as soon as they return home.
Returning to Work Post-RALP
Most patients can return to work within a few days of surgery. If a patient’s day-to-day job requires strenuous activity, this individual may need additional time to recover before returning to work.
Medication After RALP
Ibuprofen or acetaminophen initially may be used to help a patient address pain following surgery. If pain persists, stronger pain medication may be prescribed. Patients are prescribed an oral antibiotic after a catheter is removed, and a urologist will provide instructions about how often to take this antibiotic. A stool softener may be used to help a patient limit constipation as well.
Diet After RALP
A bland diet often is recommended after surgery. Patients should avoid carbonated beverages, and in some instances, may prefer a temporary liquid diet. After a patient experiences a bowel movement, this individual can start consuming soft foods like oatmeal and soup. Patients should spread out eating throughout the day with small meals and snacks and avoid large meals for the initial days following treatment.
The recovery process following robotic-assisted prostate surgery usually lasts about two to three weeks, depending on a patient’s age and overall health. A urologist is available to provide support throughout the recovery period to ensure a patient can achieve the optimal treatment results.
How long does a RALP procedure take to complete?
On average, a RALP surgery requires two to three hours to perform. Also, the procedure is often completed under general anesthesia.
Does the da Vinci System perform the actual RALP procedure?
The da Vinci System is always controlled by a surgeon – without exception. A surgeon uses the da Vinci System’s robotic arms to operate within small spaces in the abdomen.
Does blood loss occur during RALP surgery?
The da Vinci System helps a patient minimize the risk of bleeding, but it does not stop blood loss altogether. A surgeon uses the da Vinci System for precise and minimally invasive dissection to control possible sources of bleeding. Moreover, pressure generated by the gas used to inflate the abdomen during surgery simultaneously provides a surgeon with an expansive view around the prostate and reduces a patient’s risk of blood loss.
Are there risks associated with RALP surgery?
Like any surgery, there are risks associated with a RALP procedure. Common RALP surgery risks include heart attack, stroke, and death. Prior to performing a RALP surgery, a urologist conducts a comprehensive patient evaluation to identify any potential risks. If there is any chance of health complications, a urologist will forego a RALP surgery recommendation and offer alternative prostate cancer treatment options.
Should I undergo RALP surgery?
There is no right or wrong answer to this question, and the answer depends on the patient. Before a patient decides to undergo RALP surgery, it is essential to meet with a urologist. An initial consultation is the first step of the RALP surgery process. It enables prostate cancer patients to obtain RALP treatment insights and determine whether the procedure is the right choice based on their personal needs.
RALP is an advanced surgical procedure that has been shown to help patients address prostate cancer symptoms. It is not right for everyone, however, and it is important for a prostate cancer patient to understand the pros and cons of the surgery.
Comprehensive Urology teaches patients everything they need to know about RALP and other prostate cancer treatments. To find out more about our prostate cancer treatment options, please contact us today at (310) 499-2756 to schedule a consultation with one of our friendly, knowledgeable prostate cancer experts.
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