Robot-Assisted Urologic Procedures

Prior to Procedure

Depending on the reason for your surgery, your doctor may do the following:

• Physical exam
• Blood tests
• Urine tests
• Electrocardiogram (ECG, EKG)—a test that records the electrical currents passing through the heart muscle
• Intravenous pyelogram (IVP)—a type of x-ray that creates images of the kidney, ureters and bladder by injecting dye into the bloodstream
• Retrograde uretogram—a type of x-ray that create images of the bladder, ureters and kidneys by injecting dye into the bladder
• Kidneys, ureter, bladder (KUB)—an x-ray of the abdomen
• Ultrasound—a test that uses sound waves to visualize the inside of the body
• CT scan—a type of x-ray that uses a computer to create images of structures inside the chest
• MRI scan—a test that uses powerful magnets and radiowaves to create images of structures inside of the chest
• Cystoscopy—a lighted tube equipped with a camera used to visualize the inside of the urethra and bladder
• Review your medications with the surgeon; you may need to stop taking some of them
• Follow a special diet, if recommended by your surgeon
• Take antibiotics, if prescribed by your doctor
• Shower the night before your procedure using antibacterial soap, if your doctor asks you to
• Arrange to have someone drive you to and from the procedure, and for help at home after your procedure
• Eat a light meal the night before , and do not eat or drink anything after midnight unless told otherwise by your doctor
• Plan to wear comfortable clothing on the day of your procedure

Anesthesia

General or local anesthesia with sedation will be given, depending on the procedure.

Description of the Procedure

The surgeon cuts several small (approximately one-centimeter) “keyhole” incisions in the abdomen. A needle may be inserted through one of these openings to inject carbon dioxide gas into the abdomen, making it easier for the surgeon to see internal structures.

The surgeon passes a small camera (endoscope) through one of the incisions, which lights, magnifies, and projects an image of internal organs onto a video screen for the surgeon to view. The endoscope is attached to one of three or four of the surgical system’s robotic arms.

The other two or three arms hold other instruments such as dissectors, scissors, scalpels, and/or forceps. These instruments are able to grasp, cut, dissect, and suture structures inside the abdomen during the operation.

Instrument Used in Procedure

Copyright © 2005 Nucleus Communications, Inc. All rights reserved. www.nucleusinc.com

While sitting at a console several feet away from the operating table, the surgeon looks through lenses at a magnified, three-dimensional image of the inside of the abdomen. Another surgeon stays by the patient during the procedure, where he or she can adjust the camera and instruments as needed.

With joystick-like hand controls and foot pedals, the surgeon at the console guides the movement of the robotic arms and surgical instruments. The robotic arms are able to perform surgical tasks with an increased range of motion than would be possible using traditional surgical techniques. In addition, the robotic arms can filter out hand tremor and translate the surgeon’s larger hand movements into smaller ones.

After the endoscope and other instruments are removed, the surgeon closes the incisions with sutures or staples, and applies a sterile dressing.

After the Procedure

Depending on the reason for the procedure, some of the tissue that was removed may be sent to a pathologist for examination (eg, in the case of prostate, bladder, or kidney cancer).

How Long Will It Take?

Usually 2-4 hours, but this depends on the type of procedure being done.

Will It Hurt?

General anesthesia prevents pain during surgery. Patients typically experience pain and soreness during recovery, but receive pain medication to relieve the discomfort. You may also feel bloated or have pain in your shoulder from the gas used during the procedure. This can last up to three days.

Possible Complications

• Urinary incontinence—inability to control urinary stream
• Erectile dysfunction
• Retrograde ejaculation—sperm ejaculates into your bladder, rather than out through the urethra; this may cause urine to appear milky white after ejaculation
• Infertility
• Urethral stricture—abnormal narrowing of the urethra
• Damage to neighboring organs or structures
• Infection
• Bleeding
• Anesthesia-related problems
• Sometimes it becomes necessary during the procedure to abandon the robotic method and perform the surgery using traditional methods (eg, traditional laparoscopic or open surgery)

Average Hospital Stay

Usually 1-2 days, but may be longer, depending on the procedure.

Postoperative Care

You will receive instructions on when and what you can eat, and how you need to restrict your activity. Your doctor will likely advise you to:

• Take antibiotics to help prevent infection
• Avoid certain medications
• Drink plenty of fluids to clear your bladder
• Eat a high-fiber diet, drink plenty of water, and use stool softeners if necessary to avoid constipation
• Avoid caffeinated beverages, alcohol, spicy foods, or other food or drink that might upset your stomach, intestines, or urinary tract
• Keep legs elevated and moving to avoid blood clots
• Resume normal activities (eg, taking daily walks) soon, to promote healing
• Limit certain activities, such as driving, walking up stairs, lifting, working, and engaging in sexual intercourse, for a period of time
• Avoid tub baths during the first two weeks after surgery
• Wash the incisions with mild soap and water