Following your Robotic Prostatectomy Surgery

The first week
The second week
Caring for your catheter
About Robotic Prostatectomy

What is a Robotic Prostatectomy? 
The surgical removal of the entire prostate gland through the use of the daVinci Robotic Surgical System for the treatment of prostate cancer.
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How is a Robotic Prostatectomy done? 
The surgeon makes 6 keyhole incisions in your abdomen. Small plastic tubes (trocars) are placed inside the incisions to keep them open while a small camera (laparoscope) and the small robotic arms are inserted. The surgeon controls the laparoscope and robotic arms to remove the prostate gland.
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What are the benefits of using the daVinci Surgical Robot? 
  • The daVinci surgical robot allows surgeons to perform complex technical operations in a minimally invasive fashion through small key hole incisions
  • Smaller incisions produce less post operative pain and shorten the post operative recovery periods
  • The robot provides the surgeon with 3 dimensional vision magnified 10 times
  • The miniature robotic instruments articulate with small wristed joints providing an extremely dexterous means to perform minimally invasive surgery
  • The robot filters any tremor of the surgeon
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What is the da Vinci Robotic Surgical System?_
The da Vinci Robotic System is a master – slave robot. It does not perform anything in an autonomous fashion. It simply replicates the surgeon’s hand movements within the patient in a miniaturised dexterous fashion.
The daVinci robot has 3 major components:
1. The robot which holds the camera and robotic instruments
2. The surgical console where the surgeon sits to view the surgical field and control the robotic arms and:
3. The stack which displays the surgical view to the rest of the operating team

The robot serves as an extension of the surgeon’s hands and eliminates the need for large incisions that are necessary in traditional open surgery.
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Will I be asleep? 
Yes: Robotic prostatectomy is performed under general anaesthetic. You are asleep for the entire operation with a breathing tube in.
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What happens when the procedure is over? 
At the end of robotic prostatectomy, the camera and robotic instruments are removed. The prostate is removed from within the abdomen in a plastic bag in one piece. The incisions are closed with absorbable sutures and surgical glue.
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Will I experience pain? 
Some discomfort is normal with robotic prostatectomy. This can usually be well controlled with the use of analgesic tablets
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How long is the hospital stay? 
Most patients are released from the hospital within 24-48 hours.
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What care will I require when I get home? 
Before leaving the hospital you will be instructed on what to expect and what you need to do. A urinary catheter will be present to drain your bladder usually for 7 days following surgery.
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How long will I need to be off of work? 
Patients who don’t perform manual labor or jobs with lifting can usually return to work between 2-4 weeks following surgery. Work involving lifting and straining usually will require 4-6 weeks off.
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Preparing for Robotic Prostatectomy

General Preparation 
General measures when preparing for radical prostatectomy include:
Weight loss:
Many of us can afford to lose a few kilos. Weight loss improves your general fitness and makes your surgery easier to perform for your surgeon
Enlisting the help of a personal training for an intensive regime prior to surgery is helpful for many men
Pelvic floor exercises:
All men should be taught pelvic floor exercises by a physiotherapist or continence advisor with an interest in mens health.
Stop smoking.
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Continence and Prostate: a guide for men undergoing prostate surgery
This resource has been developed to educate men about the incidence of urinary incontinence following prostate surgery and provides a range of practical information to assist men pre and post operatively including pelvic floor exercises.  Click here to download - Continence and prostate - a guide for med undergoing surgery
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Nutrition, exercise and prostate cancer
A guide for men affected by or at risk of prostate cancer incorporate key elements of nutrition and exercise into their lifestyle.
Click here to download - Nutrition, excercise and prostate cancer
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4 WEEKS BEFORE SURGERY: 
It is important to stop taking herbal medications before surgery as they may interfere with your anaesthetic or predispose you to bleeding. The following list contains SOME of the more frequent herbal medications, which should be ceased 4 weeks before the surgery.
  • Echinacea, Ginseng, Kava-kava, Licorice, Saw Palmetto
  • St.John'sWort, Vitamin E, Garlic, Ginger,
Inform us if you are taking aspirin, plavix, anti-inflammatory drugs or warfarin
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ON THE DAY OF YOUR PROCEDURE: 
Take your regular medications (other than as above) as usual with a sip of water at 6:00 am.

DO NOT HAVE ANY OTHER FOOD OR DRINK BEFORE THE OPERATION
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Following your Robotic Prostatectomy Surgery

THE FIRST WEEK: 

Pain:
During the first 3 days following your operation take regular panadol (2 tablets 4 times a day). It is helpful to take this whether you are feeling pain or not as it can help prevent the pain from starting and escalating. You will also be discharged from the hospital with a stronger pain killer to take if required. Do not take any medication you are allergic to.
Initial discomfort is common and is often described as “I feel like I have done a hundred sit-ups’
If pain is more severe please notify us
Some gas pains can occur until the bowel function begins to return


The Incisions:
You will have 6 small incisions and 1 incision for specimen extraction. They will often have surgical glue on them. The glue will wear off in 3-4 weeks
A small amount of drainage from the incision is normal.
It is not uncommon to bruise around the incision site. It can even develop 1-5 days after surgery.

The Foley Catheter:
You may experience some discomfort where the catheter inserts. It can be helpful to put a small amount of Vaseline on the tip of the penis and catheter several times a day.
You may experience a small amount of urine leakage around the catheter. You may want to put an absorbent pad (such as Depends) in your underwear to soak up any leakage.
After activity or a bowel movement, you may have bloody drainage around the catheter or in your urine. This is not a cause for concern.
Your urine may be blood stained and the degree can vary throughout the day. It will often be worse after activity. Keep a good fluid intake to help clear the urine. If the amount of blood in the urine is heavy and there are blood clots coming through the catheter please notify us.
Should your catheter stop draining urine and you leak large amounts of urine about the catheter then it may be blocked. This happens rarely but if it does you will need to notify us.

Swelling of the Scrotum, Testicles or Penis:
Some patients may experience swelling and or bruising in this area after the surgery
To help reduce swelling roll up a small towel and place it under the scrotum to elevate it when lying down or sitting
You may experience some pain in the perineal area, which is between your scrotum and anus. This is usually relieved by simple analgesics and will resolve over a couple of weeks following the operation

Diet and Bowel Movements:
Following the surgery it can take several days for your bowels to begin functioning properly. During this time you can feel distended and may experience gas pains. Belching can occur. It may be a few days before you begin to pass gas and it can take 4-5 days before your bowels begin to work. Do not try and force a bowel movement.
Aim to drink 2-3 litres of water per day. Initially you may not have an appetite. Eat small amounts of food for the first few days – more like half of what you would typically eat.
Initially eat light meals such as soups, toast and pasta.
Once you begin passing gas, you may return to your regular diet
You will receive a prescription for stool softener when you leave the hospital. It is important no to strain or bear down at the toilet after your surgery.
After activity or a bowel movement, you may have bloody drainage around the catheter or in your urine. This is not a cause for concern.

Physical Activity:
Regular walking after your surgery is important for your recovery.
Don’t exert yourself more than this for the first 6 weeks. No cycling, running, jogging, weights, sit-ups, swimming, beach etc
Don’t lift more than 5 Kgs for 4 weeks after surgery (including luggage and children).

Showers and Baths:
You do not need to cover your incisions
Avoid tub baths, hot tubs, swimming pools and the ocean for four weeks after surgery.
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THE SECOND WEEK: 
You will return to the hospital 7days after surgery. You will book in at admissions then go to the ward. On the ward your catheter will be removed and your voiding will be monitored for a period of time. You will be given antibiotics to commence the night before your catheter is removed. Do not take any medication you are allergic to.

If your job is primarily sedentary (sitting at a desk) you can usually return to work in 1-2weeks. If your job is physically demanding, you will typically require 4-6 weeks off work.
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CARING FOR YOUR CATHETER:

What is a Foley Catheter?
The Foley Catheter is a flexible tube that passes through the urinary opening into your bladder. Its purpose is to drain urine. There is a small balloon inflated with water at the end of the catheter in your bladder, which keeps it in place.

What is a Leg Bag?
The leg bag is a smaller drainage bag that can be attached to your leg for convenience.

Caring for your Catheter
Supplies Needed:
Soap and warm water
Washcloth and dry towel
Leg Strap

Caring for Your Catheter:
Gather the supplies.
Wash your hands with soap and warm water.
Gently wash the following areas with soap and water:
around the catheter, the catheter tube itself
the foreskin, penis and scrotum.
Wash twice daily; morning and evening.

Caring for your Drainage Bag and Emptying the Bag:
The catheter remains connected to a drainage bag, which collects the urine. You have the option of using the larger Foley bag that can be hung from the bed, etc. or the small leg bag that is strapped to the leg.
With either bag you must:
Make sure the bag remains lower than your bladder to ensure drainage.
Keep the tubing kink free.
Empty the drainage bag when it is just over half full. It is important to remember whether you are wearing the large or small bag as the small one will need to be emptied more frequently.
After you empty the bag, close the clamp so it will collect urine again.

Call your doctor or nurse if:
The urine is heavily blood stained and contains blood clots
The urine is not draining – your bladder may feel full and large amounts of urine may leak around the catheter (small amounts of leakage about the catheter is normal).
Your catheter falls out
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Wesley Urology Clinic
Suite 42, Level 4 Wesley Medical Centre
40 Chasely St, Auchenflower, 4066
p: (07) 3720 6920
f: (07) 3720 6921

Consulting at:
Wesley Hospital

Operating at:
The Wesley Hospital
Chermside Day Hospital

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Copyright © 2011- Geoff Coughlin