Frequently Asked Questions
Where will I have my surgery?
Community Regional Medical Center (downtown Fresno), and Saint Agnes Medical Center are the only two local hospitals that have a daVinci robot. Dr. Leung does robotic surgeries at Community Regional Medical Center all day on Fridays, and at Saint Agnes Medical Center Tuesday afternoons. It is up to you where the surgery is done, although your insurance may have a location preference.
What is the robotic surgical system made up of?
The robotic surgical system is made up of three major parts. There is a camera that allows the surgeon to view the area to be worked on. The system has robotic arms with tools the surgeon uses to do the procedure. There is also a special worktable to allow the surgeon to view the site and control the tools.
How is a Robotic Prostatectomy done?
A few small holes about the size of a dime are made in the skin on your stomach. A small plastic tube (port) is put through the holes. The port keeps the holes open. A very small camera (laparoscope) and small robotic arms are put through the ports to allow the surgeon to see inside. From the worktable, the surgeon moves the laparoscope and small robotic arms to cut out the prostate.
Will I feel any pain?
You will be put to sleep for this procedure. You will not feel any pain during the procedure. You will have a small amount of pain after the procedure. Generally, taking occasional pain pills is sufficient to control pain for most patients.
How long will the procedure take?
Most often, this procedure takes 2 hours, but is dependent on the size of the patient’s abdomen and prostate. Larger abdomens and prostates are usually longer cases, and is usually a disqualifier for surgery. Also, anesthesia administration and robot set-up may take an additional 1-2 hours.
What happens when the procedure is over?
At the end of the surgery, the robotic arm and tools are withdrawn. The surgeon will close the incision holes with sutures. You will then go to the recovery room until you are awake and your blood pressure, pulse and breathing are stable.
What happens if there is a malfunction with the daVinci System?
In the unlikely event of robot malfunction, or if Dr. Leung feels that it is not safe to continue with the robot, the da Vinci system will be withdrawn and the surgery can proceed laparoscopically without it. Dr. Leung also has the option of converting the robotic surgery to perform the procedure with a longer incision as in the traditional open manner. The instruments and supplies necessary to perform either surgery without the da Vinci are kept on hand so that conversion, if necessary, can occur seamlessly. It is important to note that the failure rate of the robotic system is extremely low.
How long will I stay in the hospital?
Dr. Leung’s goal is for you to be released from the hospital within 24 hours, and 95% of his patients are able to go home the next day around noon.
How is this procedure better for me?
- Better cancer control. The robotic tools allow for the surgeon to look for any cancer of the prostate much more clearly.
- A shorter hospital stay. The small surgical incisions help people be able to get up and walk by yourself sooner.
- A low risk for blood loss. There is usually just a small amount of bleeding and this allows you to heal faster.
- Most people have little or no need for pain medication. Pain is not a problem for most patients after this surgery. You will be given pain medication to take at home if needed
- Better control of urination. In many studies, robotic prostatectomy performed by a high- volume experienced surgeon have been shown to be superior over traditional open surgery in urinary control. In these studies, patients tend to have a quicker and better recovery period of urinary control. Of course, the degree of recovery can vary widely among patients as many other factors can contribute to how well a patient recovers after surgery.
Are there any risks to this procedure?
As with any type of surgery there are risks involved with a robotic prostatectomy. Although rare, complications and adverse outcomes do occur with robotic surgery. Risks for robotic prostatectomy can be:
- Bleeding, infection, injury to internal organs.
- A part of the tissue in the stomach can poke out through the hole that was made in your
skin (hernia) where the “ports” are placed.
- Anesthesia risks including heart attack, strokes, and medication reaction.
- Blood clots could develop in the veins of the legs and pelvis.
- Scar formation at the site where the bladder was reconnected to the urethra.
Will I be able to have sex after this surgery?
It takes time for the nerves that are around the prostate to heal and function. These nerves are what cause an erection. It takes most men 9-24 months after this surgery before they are able to have an erection that is suitable for sex. Many men have partial erections before this estimated time.
Will I need to donate my own blood prior to having surgery?
One of the many benefits of the da Vinci robotic approach is minimal loss of blood. In over 600 daVinci cases, Dr. Leung has transfused less than one percent of patients having this surgery. Therefore, it is not necessary to donate your blood
Will this operation render me sterile?
Yes, all patients undergoing radical prostatectomy will not be able to father children after the procedure. However, the nerves that give the ability to have erections can be spared allowing many patients to continue to have erections and climax after the surgery. There will be no ejaculation as the prostate is the organ that produces the ejaculate.
What care will I need at home after this surgery?
You and your caregiver will be taught about your care before you leave the hospital. You will have a catheter for urine until your first visit with Dr. Leung, which is about 5-7 days after surgery. You will have an x-ray called a cystogram at that time. This x-ray helps check your healing to see if the catheter may be removed. Patients are able to have their catheter removed one week after surgery 95% of the time.
How long will I need to be off of work after this procedure?
Most men may need to be off work for 2-4 weeks after surgery. If your work requires you to do heavy lifting you may need to stay off work longer. Dr. Leung will take all of this into consideration when determining the length of your work release. Generally there are fewer risks with this procedure and most men heal quicker, so you should also return to work at a faster rate.
How safe is the da Vinci Robot for Laparoscopic Prostatectomy?
The da Vinci robot is FDA approved for radical prostatectomies and is being used routinely in over 300 locations worldwide.
Does tactile sensation have an effect on the outcome of the surgery?
Tactile sensation, the ability to perceive through touch, is an important part of open radical prostatectomy surgery. The surgeon usually uses this sense in the portions of the operation where he or she is not able to see clearly. Although with da Vinci robotic surgery true tactile sensation is lost, the ability to move the robotic camera to difficult locations within millimeters of where Dr. Leung is working allows him to see things an open surgeon cannot, and do so with the 12 fold magnification of the robotic camera. Furthermore, Dr. Leung has found that with experience, a pseudo-tactile sensation is developed and an appreciation of tissue texture and density is achieved. The combination of enhanced vision and experience with tissue handling more than compensates for the lack of real tactile sensation.
To test for cancer cells outside of the prostate, Dr. Leung sometimes sends tissue biopsies around the prostate to the pathologist if he sees a need during the surgery.
Are there any activity restrictions?
You should not engage in any strenuous activities such as exercise or heavy lifting for one month after your surgery. Walking a moderate amount, however, is encouraged. You may begin to drive only when you are off pain medications and after your catheter has been removed.