Robotic assisted radical prostatectomy (Da Vinci)
Dear patient,
We hereby would like to inform you on your surgery and the postoperative course. A robotic assisted laparoscopic removal of your prostate is planned with the Da Vinci system. This is a minimal invasive procedure offered in our centre for the treatment of prostate cancer.
The goal of the procedure is to remove the prostate with the seminal vesicles and the lymph nodes near the pelvic vessels. Small skin incisions are made to introduce a camera and several instruments in the abdomen (so called “keyhole surgery”). The surgeon will be able to have a 3-dimensional high definition view in order to manipulate the robotic instruments. The robot will not do anything by itself, the system helps the surgeon’s movements by increasing their precision.
The part of the ureter going through the prostate will consequently also be removed. The bladder will therefore be sutured to the ureter. This surgical connection is called an “anastomosis”. During surgery we will introduce a urinary catheter in your bladder.
Progress of your hospitalization
After the surgery you will pass several hours in the anaesthetic recovery room and then be transferred either to your room or to the intermediate care ward (ward 2A). In the latter case you will normally return to the normal ward one day later. You will be able to leave the hospital with the urinary catheter in place at day 3 to 5 after surgery. The catheter will generally be removed at day 5 to 7 after a radiological control of the anastomosis in an ambulatory setting.
In seldom cases it will be necessary to leave the catheter in place for a longer period.
Thrombosis
You will be given a daily heparin injection and antiembolism stockings in order to prevent a thrombosis. You will have to continue the heparin injections at home, further informations will be given in the discharge letter.
Urinary catheter
A urinary catheter will be introduced in your bladder during surgery. At the end of this catheter, in the bladder, a balloon will prevent the catheter from falling out. Generally the catheter will be removed at day to 7 after a radiological thightness control of the anastomosis.
Some time will be necessary to regain complete control of your sphincter after surgery. In order to help shorten this time you need to train the sphincter. This means you should try to keep the urine as long as possible in your bladder.
After removal of the catheter we will deliver you a medical prescription for physiotherapy of the pelvic floor. You can present yourself with this prescription at the physiotherapy department of Hôpital Kirchberg (or any other physiotherapist specialised in male pelvic floor) in order to get a short term appointment. This will significantly reduce the time for regaining continence.
Suturing material
Your skin will be sutured with auto-resorbable material which makes an extraction obsolete. Additionnaly to this we will apply seal the wound with a special wound-glue which will also disappear by itself. In the rare case of staple use a removal will be scheduled for approximately 10 days after surgery. Scapformation and limited reddening of the wound are to be seen as normal and are not dangerous.
Showering
You will be ale to take a shower one day after the surgery (after counseling with the nurses on your ward). Avoid « extensive » showering, your bandages will be replaced after showering. The catheter can be taken to the shower, avoid cleaning it with soap as this can lead to an irritation of your urethra.
What is « normal » after this type of surgery?
- Abdominal distension, constipation
- Small reddenings around the skin incisions
- Weight gain. Retur to normal should be expected in approx. 14 days
- Swelling/Hematoma of the scrotum, up to an extent of a grapefruit. Retur to normal should be expected in approx. 14 days. An elevated position (f.ex. with a furled piece of tissue) or local cold while in seating or horizontal position can help loweing the swelling.
- Urine/Blood loss around the catheter. Most often after physical activity. This is not dangerous.
- Vesical cramps which manifest themselves by a short pain in the lower abdomen, an urgent need to urinate or a burning sensation in the urethra.
To what should you pay attention?
- Regularly and soft defecation.
- Be sure not to bend/kink the catheter.
- Please inform the nurses if you notice that urine production through the catheter stops and that you have the strong need to urinate.
- Please try to drink enough (min. 2 liters per day)
What should you avoid?
- Physical exercice during 4-6 weeks
- Pressing during defecation
- Avoid pelvic floor exercices while te catheter is in place.
- If you take a medication that fluidifies the blood (f.ex. Aspirine, Sintrom), make clear with your docor at waht point you can start taking them again.
When will you have to cantact or visit your doctor?
- Fever
- Non tolerable pain even after correct intake of your medication
- Loss of the catheter
- Continously turbid and smelly urine
- If the catheter is blocked In case of swelling and or pain in one leg
- Nausea and vomiting
Medical and oncological follow-up
We recommand and offer you regular follow-ups at your urologist’s office after surgery. Generally a short-term appointement and an appointement at 3 month will be necessary.
Psychooncologic counseling
Accepting the disease is an important step. Open discussions with relatives can be difficult, it can be easyer to open yourself to a « stranger ». In case of need we recommand to contact a psychologist or a psychooncologist who is used to this situation. Using this opportunity is absolutely no sign of psychic disorder but rather on occasion to have a professionnel counseling in order to overcome this diffcult step in your disease. We will offer you a contact during your stay at the hospital. Do not hesitate to actively ask for it.
Leaving the hospital
After your discharge consultation your doctor will provide you a letter containing all important elements for your general practitioner. Please organize a short-term visit at his office in order to hand him over the letter which may contain informations on eventually necessary auxilliary measures.
Support group
Patients with prostate cancer can get in contact with a support group. In case of need you can contact either one of these groups :
Prostataselbsthilfe Saarbrücken
www.prostata-selbsthilfe-saarbruecken.de
Tel. +49 681 87 28 81
Association Nationale des Malades du Cancer de la Prostate (ANAMACaP)
www.anamacap.fr
12, rue de Partarrieu 33124 Auros France
Tel. +33 5 56 65 13 25 (Permanence téléphonique du lundi au vendredi de 9h à 13h)
1000 BRUXELLES – Institut Jules Bordet Interventions de soutien après les traitements pour les patients atteints d’un cancer de la prostate.
Contact (Isabelle Merckaert) : Tel. +32 2 541 33 26
Useful links :
Fondation cancer
209, route d’Arlon L-1150 Luxembourg
Tel. +352 45 30 331
e-mail : patients@cancer.lu
Prostataselbsthilfe Saarbrücken
Sittershöhe 14 D-66130 Saarbrücken
Tel. +49 681 87 28 81
www.prostata-selbsthilfe-saarbruecken.de
Throughout your course, the medical staff is at your disposal to answer your questions.
USEFUL INFORMATION
Should you encounter problems please advise to your treating urologist (Tel. +352 22 36 34), one of his colleagues or to the urological Polyclinique at Hôpital Kirchberg (ground floor Hôpital Kirchberg, Tel. +352 2468 5870).
We wish you a good recovery and are at your disposal for urgent needs, even after your discharge (Tel. +352 2468 1).