General | Pre-Operative | Post-Operative

General

Q: Why choose the da Vinci^® prostatectomy (dVP)?

Recent studies of several hundred patients show that the da Vinci^®robotic-assisted anatomic radical prostatectomy or da Vinci^® prostatectomy (dVP) is as effective as standard prostatectomy in treating prostate cancer. The dVP is generally associated with less postoperative pain, fewer complications, shorter hospital stays and a faster recovery.

In the hands of surgeons at the Urology Center of Florida, robotic technology is enabling the next generation of prostate cancer surgery. 

Compared to open surgery, the dVP offers:

• Less pain 
• Fewer complications 
• Shorter hospital stays 
• Faster recovery 
• Earlier return of urinary control 
• Improved sexual function 
• Less internal scarring

Q: How experienced is the Urology Center of Florida in this procedure?

The Urology Center of Florida is among the nations leaders in performing the da Vinci^® prostatectomy (dVP). On average, our surgical team led by Dr. Locke, completes between 3 and 5 procedures per week.

Q: Where is the dVP performed?

The dVP is performed at West Marion Community Hospital in Ocala, Florida. West Marion Community Hospital, is Marion County's newest Healthcare neighbor. The new $55-million, 70-bed facility and adjacent Medical Plaza opened September 10, 2002 to serve the community's growing population.

West Marion Community Hospital is the only facility in Marion County offering all-private rooms, hospital-based MRI, film-free imaging technology and a completely smoke-free campus. The 54-acre campus, situated just 1.5 miles west of Interstate 75, features a three-story, 112,000 square-foot facility fully staffed and has the technology to ensure a comfortable stay for our patients undergoing the dVP procedure.

The new hospital provides full medical services, including a trauma-ready emergency department offering medical treatment 24-hours a day, year round. Three operating suites feature a full range of options, from traditional surgery to minimally invasive and robotic procedures. West Marion Community Hospital also offers complete radiological services, laboratory procedures, respiratory testing, therapy and a variety of outpatient services.

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Q: Does the dVP result in cancer cure rates comparable to conventional surgery?

Yes. Conventional surgery results in very high cancer cure rates and has long been considered the gold standard by which all prostate cancer treatments are measured. In general the cure rates achieved with surgery are related to the pathologic extent of disease and the surgical technique employed. Theoretically, because of its precision, the completeness of cancer removal and subsequent cure rates should be higher for the dVP than with conventional surgery.

Q: What happens if the da Vinci^® Surgical System (the Robot) mechanically fails during the surgery?

In our experience this has not happened. If the da Vinci^®Surgical System should mechanically fail during surgery, the procedure would be completed using either conventional laparoscopic or the open surgery.

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Pre-Operative

Q: How long does the operation take?

Excluding any unusual circumstances, the actual procedure takes 2 to 2.5 hours if the lymph nodes are not sampled and 2.5 to 3 hours if the lymph nodes are sampled. 

Q: Will I need to donate my own blood to have on hand during surgery if the need for a transfusion arises?

One of the many benefits of the dVP is minimal loss of blood. Therefore, it is not necessary to have your blood available for transfusion.

Q: Will this operation render me sterile?

Yes, all patients undergoing radical prostatectomy will be rendered sterile (i.e., will not be able to father children) after the procedure.

Q: Does the dVP require general anesthesia?

Yes. The dVP is a major operation and would be intolerable without anesthesia. During a dVP, the operating table is positioned such that the patient's head is lower than his feet (Trendelenburg). Also, the patient's abdomen is filled with CO2 to a pressure of 15 mm Hg. Under such conditions, a sedated patient cannot breathe on his own. For these reasons, the dVP requires general anesthesia with full intubation.

Q: Does prostate size matter?

Prostate size is a consideration but not a contraindication to the dVP. Very large prostate size can contribute to the complexity and time required to complete the procedure. Our surgical team routinely remove prostates ranging from 10 to >200 cc in size.

Q: Can lymph nodes be removed during the dVP?

Yes. Staging lymphadenectomy can be performed if clinically warranted. Fortunately, since the availability of PSA testing, prostate cancer is typically diagnosed at a much more favorable stage thereby lessening the need for lymph node removal.

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Q: What risks are associated the dVP?

The dVP is major surgery, done under general anesthesia and carrying the general risks of any major operation including heart attack, stroke, and death. The dVP is also associated with the risks of adjacent organ injury, impotence, and incontinence.

Q: Can the neurovascular bundles be preserved?

Yes. The neurovascular bundles, whose preservation is associated with the likelihood of maintaining erections, are located outside the prostate and thus in patients with organ-confined cancer can be preserved safely. However, nerve preservation does not guarantee satisfactory erections following surgery.

Q: What determines the likelihood of maintaining erections after surgery?

Many factors influence postoperative potency, including preoperative erectile function, patient age, pathologic extent of disease, surgical technique, and anatomic variation. Patients who are young, healthy and have organ-confined disease are the best candidates for cure and also have the best chances of recovering sexual function. 

Q: Are venous compression devices used during the dVP? 

Yes. Venous compression devices are used during surgery as a precaution against clots forming in the large veins of the lower extremities. 

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Post-Operative

Q: How long can I expect to stay in the hospital after the procedure?

Most dVP patients are able to go home the day after surgery.

Q: After the dVP, when will I be able to resume normal activities?

One of the major advantages of the dVP is decreased recuperation time. Thus, most individuals undergoing this operation will be able to resume normal activities after two weeks.

Q: Can I bathe after the dVP?

Yes. 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.

Q: How long should the catheter stay in?

Most patients can have their catheters removed within 5 to 7 days following surgery.

Q: What can I expect after the catheter comes out?

Almost all patients will experience some degree of incontinence immediately following catheter removal. Urinary control returns with time and may be hastened with the use of Kegel exercises, which help strengthen the voluntary urinary sphincter muscle.

Q: When will I have complete urinary control after the dVP?

Results following our initial 250 operations show that 84.8% of patients treated at our institution experienced early return of urinary continence, defined as wearing no pads or a small liner for security purposes, at one week following catheter removal. This trend continued and at 1, 3, 6, 12, and 18 months following surgery 94.4%, 96.7%, 98.0%, 98.7, and 98.7% of the patients were dry, respectively.

Q: When will I be able to have sexual intercourse after the dVP?

Results following our initial 250 operations show that men reporting normal preoperative erections (SHIM >21), potency returned gradually, reaching 85.4% at 12 months and 91.7% at 18 months.

Q: What is the long-term follow-up after the dVP?

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 3 months following surgery and then every 6-12 months thereafter.

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