Robotic Prostatectomy

We’re nearing the end of week two and I definitely feel like I've settled into the routine of things here. As well, a few things have come to my attention reinforcing the fact that I do not want to be a doctor. First of all, the early mornings, I'm usually not even awake enough to drink a cup of coffee before our 7:30am surgeries, yet the surgeons and nurses are alert and ready. Secondly, I have to write everything down and then reference my notes to remember the terms and anatomy, let alone the details of any given case. With these two realizations I’ve adjusted my lifestyle for the time being by going to bed early and always carrying pen and paper.

On to more interesting things: my clinician’s most frequent surgeries are robotic prostatectomy and robotic cystectomy. At this point I’ve learned how a patient proceeds through the diagnosis, treatment and recovery of both and thought I’d outline the general process for prostate cancer patients in this blog. As well, if anyone wants to watch a robotic prostatectomy there are a few sites you should check out in advance to better understand what you are seeing. The first link is an anatomical animation of a prostatectomy and the second is a video of a prostatectomy with commentary.

In general, patients with prostate cancer present with an elevated PSA (prostate-specific antigen) score. Patients are then further classified by stage and grade. These levels are defined by the results of a TRUS (Trans-Rectal Ultrasound Guided Biopsy) which can be performed during an outpatient visit. Biopsies are done through the rectum, under local anesthesia, with the guidance of ultrasound visualization of the prostate to ensure biopsies are taken from different locations throughout the prostate. The results of these biopsies are then combined to determine the patient’s Gleason score. At this point, the patient is advised as to which treatment they should consider: radiation, open surgery or robotic surgery. This consultation also takes into affect the patient’s age and current general health status.

If the patient opts for robotic prostatectomy, the surgery generally follows this video’s commentary. Two valuable aspects of robotic surgery are: 1) the ability to spare the nerves required for erectile function and 2) the ability to take biopsies during the surgery and have them immediately analyzed by cytology to ensure that all cancerous tissue is removed.

Last, the patient recovers in the hospital overnight and usually heads home the next day. They keep a catheter in their bladder to allow the new urethro-bladder junction to heal. Postoperatively, urinary control returns followed by erectile function. The recovery period varies by patient and generally tends to depend on age as well. Patients are then followed after surgery every few months for the first year and over progressively increasing time intervals for the years to come. Follow up visits usually include a conversation about the status of urinary and erectile function and a rectal examination of where the prostate was removed to ensure no re-growth has occurred. Overall, the process from diagnosis to recovery is definitely stressful for the patient but often results in very happy conclusions.