Robot-Assisted Radical Prostatectomy (RARP) is fast becoming standard care for prostate cancer care in developed countries throughout the world. While maintaining advantages of laparoscopic prostatectomy, RARP allows surgeons the benefits of 3D optics, control of the camera, wristed instrumentation & simultaneous use of multiple instruments which are unachievable with traditional laparoscopy procedures. RARP in this decade has become one of the most commonly used approaches for prostate cancer surgery. Urologists associated with IndianMedTrip have great expertise at RARP for high-risk prostate cancer, nerve-sparing RARP & RARP in complex cases like those in patients with prior pelvic, abdominal and/or inguinal surgery. Cases referred by IndianMedTrip are individually reviewed by the concerned operating specialists.
Like it is with most other surgical approaches, prostate cancer surgery patient will also have to avoid certain medications prior to undergoing prostatectomy. However, they must consult the operating team prior to discontinuing any medications that they have regularly been taking. Patients must also not drink anything except for clear liquids after midnight before the day of surgery & follow various other instructions provided by the operating team.
RARP is a well established surgical procedure which is performed by well-experienced & a dedicated team of medical professionals which includes urologists, anesthesiologists, nurses & operating room technicians. Robotic prostate cancer surgery normally utilizes the da Vinci surgical system & which is a highly sophisticated robotic device providing live 3D camera imaging of the prostate gland & surrounding tissue during laparoscopic radical prostatectomy procedure. Keyhole sized incisions are made within the pelvic region of the patients after they have been anesthetized for the operation. Miniature robotic instruments are inserted through these incisions which allow surgeons to dissect the prostate gland & sew bladder to urethra with ultimate precision. The magnified view provided by the 3D camera allows surgeons to preserve delicate structures like nerves, blood vessels & muscles while dissecting the cancerous prostate gland. The pelvic lymph node may or may not be a part of the robotic operation depending upon the risk profile of the patient’s cancer. Finally, the dissected prostate is placed within a watertight entrapment sac & removed intact through the keyhole incision. A catheter is subsequently placed through the penis in order to drain the bladder & allow healing of the reconnection. Small drains are also placed around the operating site through keyhole incisions.
The operating surgeon is seated at a computer console for the most part of the surgery & from where they effectively manipulate wristed robotic instruments with finger control. The entire surgical procedure is performed by adhering to the same anatomic principles of open prostate cancer surgery without the hands of a surgeon entering the body of a patient. Results of RARP regarding cancer cure, sexual potency & urinary continence confirm with that of open surgery regardless of preoperative risk stratification but are found to depend more upon the patient, the status of cancer & the surgeon’s expertise.
Duration of robotic-assisted radical prostatectomy generally ranges in between 2 – 4 hours of time from one patient to another depending upon the shape of the pelvis, the size of prostate gland, the weight of the patient & the presence of inflammation or scarring within the pelvic region due to prior pelvic or abdominal surgery or infection. Moreover, blood transfusions during RARP are rarely required as blood loss during surgery is routinely less than 300 ccs. However, donation of blood by patients prior to surgery for autologous blood transfusion can be arranged if desired.
Although RARP has proven to be extremely safe, there are some inherent risks which are invariably involved with all types of surgeries. While safety & complication rates of RARP compare favorably with open prostate cancer surgery, potential risks, however, include the following.
The patient will be first taken to a recovery room following RARP & then transferred to a regular hospital room once they are fully awake & the vital signs are stable. Duration of stat at the hospital for most RARP patients is 1 – 2 days of time. While patients are at the hospital they can expect to have an intravenous catheter in order to receive necessary fluids & to stay hydrated along with administering of medications. Moreover, patients normally advance to a regular diet on the day after surgery. Some patients may experience minor transient shoulder pain following surgery which is related to carbon-dioxide gas that is normally used for inflating the pelvic region during RARP surgery. Bladder spasms are also commonly experienced due to moderate cramping sensation in the bladder or lower abdomen region. Transient nausea is also expected to be experienced during the first 24 hours following operation. Fatigue is also common but which usually subsides within a few weeks time.
RARP patients can expect some discomfort at the site of incisions which may require pain medications for a few days. Patients may, however, shower at home but should take care to pad-dry incision sites. Tub baths are not recommended within the first 2 weeks following surgery. Sutures applied to incision will naturally dissolve within 4 – 6 weeks of time & which will barely be perceptible in due course of time. Adhering to simple foods like soups, noodles & rice is advised instead of fiber meals like vegetables as intestines may take up to a weeks’ time to recover from surgery & anesthesia. Moreover, spicy foods, alcohol & drinks with caffeine may cause irritation because of raw surface of bladder & urethra. Activities of RARP patients should invariably include daily walks as prolonged sitting or lying can increase the risk of formation of blood clots in legs. However, driving should be avoided for the first 2 weeks of time following surgery. Most RARP patients are generally found to return to full activity between 3 – 4 weeks following robotic prostate cancer surgery. Nevertheless, lifting heavy loads or vigorous exercises like swimming, jogging or biking are not recommended for 4 weeks following surgery or until they are permitted by the doctor. Caring for the catheter is very important & which allows healing of bladder to the urethra. It should therefore effectively & continuously drain & should not be put on tension anytime. Most patients can also resume usual medications following RARP surgery with exception of blood thinners like aspirin since they increase the risk of bleeding. It is, however, better to check with the surgeon about the resumption of medications.
Also known as Pelvic Muscle Exercises, Kegel Exercises are meant to strengthen the group of pelvic floor muscles so as to improve bladder control in men. These muscles typically contract & relax under command in order to open & close the bladder. However, building strength & endurance of these pelvic floor muscles require regular exercise. It is also recommended that RARP patients begin doing Kegel exercises 6 – 8 weeks prior to undergoing robotic prostate cancer surgery. However, it would be best to ask the urologist to help in identifying proper muscle contraction in case patients are unsure as to exercising the correct muscles.
India offers an excellent opportunity for international patients to undergo world-class robotic prostate cancer surgery at affordable costs. Urologists & oncologists in India are considered to be some of the best doctors in the world & are adept at performing complex surgeries with help of the latest technologies. IndianMedTrip is a globally reputed healthcare service provider which is based in India. Closely associated with top oncology surgeons & internationally accredited multispecialty hospital facilities in the country, IndianMedTrip is well placed to offer the most competitive treatment packages to overseas patients without any waiting period.