Patient Selection

Patient selection is essentially the same as for conventional open radical prostatectomy. In general, the ideal candidates for the dVP are men who have localized disease (Stages T1 and T2); PSA levels less than 20 ng/mL and a Gleason score of less than eight. Finally, the dVP is usually restricted to men who have a ten-year or more life expectancy and are in sufficient health to withstand the risks of major surgery.

Pre-Operative Preparation

Routine pre-operative testing is performed which includes: History and Physical Examination, Electrocardiogram, Chest X-Ray, Complete Blood Count, Coagulation Profile, Comprehensive Metabolic Panel, and Urinalysis.

Since the risk of blood loss and transfusion are minimal with the dVP, autologous blood collection is not required.

A clear liquid diet is started the day prior to surgery. Patients are instructed to drink one bottle of magnesium citrate on the evening before surgery and administer a Fleet enema at home the morning of surgery to help evacuate the bowel contents.

Patients should receive nothing by mouth for at least six hours prior to surgery. They are admitted to the hospital on the day of surgery. Antibiotic prophylaxis is administered and sequential compression stockings are applied in the pre-operative holding area.

The Operation

The dVP is performed through 6 small 1-cm incisions across the mid abdomen. Through these small incisions, fine laparoscopic instruments are inserted to dissect the prostate gland, seminal vesicles, and vasa deferentia from the urethra and bladder adhering to the same anatomic principals of open surgery. Excellent visualization of the prostate gland and the surrounding neurovascular structures is achieved with the use of a high-powered telescopic lens attached to a camera device. Once the prostate gland is dissected free from the bladder, rectum, and urethra, it is placed in a small plastic bag and eventually removed by extending one of the small 1-cm incisions to accommodate the prostate. The bladder is sewn back to the urethra to restore continuity of the urinary tract. A catheter is placed through the penis to drain the bladder and allow healing of the bladder-urethra connection. In addition if required, a small drain is placed near the surgical site, exiting one of the small 1-cm incisions.

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Potential Risks and Complications

Although proven very safe, the dVP is major surgery, performed under general anesthesia and carries the potential risks and complications of any major operation including heart attack, stroke, and death. In addition, the dVP may be associated with the risks of impotence and incontinence. Other potential risks include bleeding, infection, adjacent tissue/organ injury, urethrovesical anastomotic leakage, port site hernia, and conversion to open surgery.

What to Expect After the Surgery

Hospital Stay: Length of hospital stay for most patients is one day.

Post-Operative Pain: Because it is performed through very small incisions, the dVP is associated with very little surgical pain. Most patients recover without narcotic medication, which reduces side effects such as lethargy, constipation, and dizziness. The reduction of pain also permits most patients to get on their feet within hours of surgery and to leave the hospital on the same or first post-operative day.

Bladder Spasms: Bladder spasms are commonly experienced as a moderate cramping sensation in the lower abdomen or bladder and are quite common after prostatectomy. These spasms are usually transient and often decrease over time. If severe, medications can be prescribed by your doctor to decrease the episodes of these spasms. 

Urinary Catheter: You can expect to have a urinary catheter (Foley) draining your bladder for approximately 5-7 days after the surgery. It is not uncommon to have blood-tinged urine for a few days to a week after your surgery.

Pelvic Drain (if required): The pelvic drain is placed in the operating room and drains the pelvic space around the bladder-urethra anastomosis. This drain is usually removed in 24 hours when the drainage is minimal.

Diet: Most patients are able to tolerate clear liquids a few hours after surgery and a regular diet later that same evening. Liberal fluid intake is encouraged.

Fatigue: Generalized fatigue is common and should start to subside in a few weeks.

Constipation: You may experience sluggish bowels for several days to a week after surgery. Suppositories and stool softeners can be used to help with this problem.

Showering: You may shower at home. Your wound sites can get wet, but must be patted dry. Tub baths can soak your incisions and therefore are not recommended in the first 2 weeks after surgery. Sutures underneath the skin will dissolve in 4-6 weeks.

Activity: Walking is strongly advised. Prolonged sitting or lying in bed should be avoided and can increase your risk for forming blood clots in the legs as well as developing pneumonia. Climbing stairs is possible but should be limited. Driving should be avoided for at least 1 week after surgery. Most patients return to full activity an average of 2 weeks after surgery.

Medications: You can resume your usual medications after surgery with the exception of aspirin or other blood thinners, which can increase the risk of bleeding. 

Follow-up Appointment: You will need to call the office soon after your discharge to schedule a follow up visit for 5-7 days week after your surgery date for removal of your Foley catheter.

Pathology Results: The pathology results are typically available within 5-7 days after your surgery. 

Long-term Follow-up: Depending on the final pathologic stage of the prostate cancer, a patient may or may not require additional cancer treatments. In either event the mainstay of surveillance will consist of periodic measurement of blood prostate specific antigen (PSA), universally recognized to be the most sensitive indicator of cancer recurrence. The initial surveillance PSA test is drawn at 12 weeks following surgery and then every 6-12 months thereafter.

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