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RAJESH LAUNGANI MD FACS |
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Frequently Asked Questions What is robotic surgery? Robotic radical prostate
surgery employs techniques of laparoscopy to place surgical ports into the abdomen and perform surgery under computer assistance
of a surgical robot attached to the laparoscopic ports. Attributes of the robotic system are: For more
information on the robotic system, please visit the Intutive Surgical Incorporated website at www.davincisurgery.com. What are the benefits of robotic radical prostatectomy versus traditional open retropubic radical prostate
surgery? Any patient newly diagnosed with localized prostate cancer, may be a candidate for robotic radical
prostate surgery. Attributes of the daVinci™ Surgical System (Intuitive Surgical Incorporated, Sunnyvale, CA) allows
your robotic-trained surgeon to visualize complex and vital structures in the pelvis. This allows for a more precise and less
invasive surgical procedure which spares crucial structures in order to offer patients a greater chance at functional recovery
after surgery. Numerous published articles in peer-reviewed medical literature (see bibliography) has shown that robotic
prostatectomy offers the following potential benefits over traditional open retropubic radical prostate surgery: Who actually performs the operation, the surgeon or
the robot? The robotic system is simply a tool and does not have the capability to perform the operation
without the surgeon. The surgeon uses the robotic instrument much as he/she would with a scalpel. It is for this reason that
patients should ask their surgeon of his experience performing the operation. Surgeons performing large volume and those with
fellowship training are more likely report better outcomes. Who will perform the robotic prostatectomy if
I choose to have the surgery at Piedmont Hospital? Robotic radical prostate surgeries are performed by
surgeons who have experience performing these procedures. Dr. Rajesh Laungani serves as the Associate Director of
Minimally Invasive & Robotic Surgery at Piedmont Hospital and received fellowship training at Henry Ford Hospital
under Dr. Mani Menon. He is recognized as a world leader in robotic surgery. Dr. Laungani teaches and proctors robotic
surgery worldwide having recently traveled to the Czech Republic, Malaysia and Egypt so as to teach other physicians
to perform this procedure. Does the entire prostate gland have to be removed or just the part(s) with the
cancer? By definition, radical prostatectomy requires that the entire prostate gland with the seminal
vesicles be removed entirely. The diagnosis of cancer is based on the biopsy which often underestimates the aggressiveness
of the cancer or the volume of cancer in the diseased prostate. Entire removal best assures the possibility of cancer-free
survival after surgery. Should the lymph nodes also be removed during robotic prostate surgery? Basically
yes. However, many Urologic surgeons will not remove the lymph nodes for patients with extremely focal and early disease.
This decision should be made between you and your trained robotic-surgeon. How long does a robotic radical
prostatectomy typically take? The actual procedure normally takes 1 ½ to 2 hours for experienced
robotic surgeons. Depending on the anatomy, presence of adhesions (scar tissue) and other factors, the operation could take
up to 1 hour longer. Is robotic radical prostate surgery performed under general anesthesia? Yes,
patients are placed under general anesthesi What is my risk of transfusion and will I need to donate blood
prior to surgery in case of a transfusion during or after surgery? Blood loss is typically 100 –
200 cc’s during robotic radical prostate surgery. The incidence of transfusion is less than 1% in experienced surgeons.
Therefore, we counsel patients not to donate blood. Tell me about urinary control after this procedure? The
external urethral sphincter is an innervated (nerves) circular band of muscular tissues that surrounds the urethra at the
base of the penis. This sphincter is responsible for maintaining continence in men after surgery. This mechanism takes time
to function completely and keep men continent. A majority of men will be continent, but will experience stress urinary dribbling
after surgery. This improves over 3- 6 months after surgery. During this time, men will often wear small pads in their underwear. Tell
me about erectile function after prostatectomy? All patients undergoing radical prostatectomy, regardless
of the type of surgery used (open vs. laparoscopic vs. robotic), will experience problems achieving and maintaining an erection.
Sensation and libido are not affected by the surgery. Based on your preoperative erectile function, robotic surgery offers
men an earlier time for erectile function recovery given the minimally invasive approach to removal of the prostate. The time
for recovery typically takes between 3 and 12 months after surgery. Given the fact that the seminal vesicles and vas deferentia
are removed, there is no emission during sexual relations after prostatectomy. How long do patients typically
stay in the hospital after surgery? Most patients (97%) are discharged within 24 hours after surgery. Who
reviews the prostate gland after surgery and when will I get that information? Dr. Laungani and Urologists
at Piedmont Hospital collaborate with expert Pathologists to review the histopathology of the prostate gland and
the lymph nodes. Specifically, the Pathologist will assess the aggressiveness of the cancer (final Gleason Grade), the pathologic
Stage of your cancer, the presence of extra-prostatic extension, and if there is extension into the seminal vesicles. All
this information will be discussed with you after surgery at your first follow-up appointment. How soon
can I resume normal activities? This is a decision based on each individual undergoing surgery. Typically
patients are able to resume normal activities within 7 - 10 days after surgery. This correlates to the same time your urinary
catheter is removed. All patients are asked to walk 6 hours after surgery with the assistance with a family member or nurse
on the ward. What are my limitations or restrictions after surgery? Patients are asked
to walk daily and may traverse stairs or steps in their home. Avoid lifting over 15 lbs. Also patients are asked to avoid
any heavy lifting, exerting or excessive physical activity. Will I have pain after the operation? Most
patients describe having discomfort as opposed to pain. Intravenous narcotics are not given, but patients are given oral pain
medications for relief. Many patients do experience abdominal bloating which is also called an Ileus. Patients are required
to maintain a clear liquid diet after surgery until their bowel function returns, which could be up to 3 days after surgery. How
long do I keep my urinary catheter after the surgery? The urinary catheter, or foley catheter, is required
to allow for healing of the connection between the bladder and the urethr In addition, the catheter allows for adequate drainage
of the urinary bladder. The catheter remains in place for approximately 7 – 10 days after surgery. When
can I resume driving? When your catheter is removed AND when you are no longer using pain pills. When
can I shower after the surgery? Patients are allowed to shower on the second day after surgery. Most patients
are home by this time. Tub baths and hot tubs are not allowed. Can the robotic equipment malfunction during
the surgery and if so, what happens then? The robotic surgical system is meticulously maintained by the
hospital and a company service representative. However, if the robotic system mechanically fails during surgery, the
procedure would be completed laparoscopically or by converting to an open surgical technique. I am from
out-of-town, are there any special arrangements that are made for patients that are not from Atlanta? Yes.
Currently, the hospital has developed a hospitality program with local hotels near the hospital. Please ask about the program
when you contact Piedmont Hospital for more information on robotic radical prostate cancer surgery. |