1What Is Robotic Surgery?
Robot-assisted laparoscopic surgery entails the use of a surgical robot to allow surgeons to offer their patients the benefits of laparoscopic surgery. The use of this technology helps the surgeon perform more complex operations without the need for a large incision. By combining robotics and state-of-the-art computer technology, surgeons can operate with greater dexterity and control than with traditional surgical approaches.
Intuitive surgical introduced the da Vinci surgical system in 2002 and it is regarded as the leader of robotic surgery. Life Kingsbury Hospital has acquired the da Vinci X, a first of its kind in Africa.
2How Does Robotic Surgery Work?
The surgeon sits at a surgical console next to the patient. The surgeon performs the procedure from the console while viewing the surgical field through a 3-dimensional (3D) magnified image (up to 10x magnification) in high definition(HD). At the same time the surgeon’s hand movements are seamlessly translated to the robot to complete the surgical procedure.
It is important to understand that the robot is controlled solely by the surgeon and is not capable of making decisions on its own. Every step of the surgery is performed through direct input from your surgeon. Through just a few small incisions the surgeon can perform the entire procedure. The range of movement of the da Vinci articulated instrument wrists are better than the human hand.
3What Are the Main Benefits of Robotic Surgery?
With robot-assisted surgery, patients can have major surgery with only a few tiny incisions. Compared to open surgery the benefits are:
- Significantly less pain and analgesia needs
- Less blood loss and much fewer blood transfusions
- Fewer complications and lower risk of infection
- Shorter hospital stay
- Faster recovery and return to normal activities
- Small incisions for minimal scarring
- Improved urine continence recovery
- Improved sexual function recovery
Benefits for surgeons include 3D HD vision, 10x magnification view, great ergonomics, improved dexterity, improved access and greater surgicalprecision.
4What makes the da Vinci X better that the other da Vinci systems?
- Sleek new design allowing streamlined setup and laser guidance for precise and safer docking of the robotic arms to the patient
- Significantly improved high definition(HD) view. This allows the surgeon to see anatomy in greater detail. The surgeon can now visualise and protect the tiny nerves next to the prostate with greater care. These nerves are very important for sexual function preservation.
- Smaller skin incision at the umbilicus as the new endoscope is much smaller than previous models and this means less pain for the patient.
- Lightweight smaller camera endoscope with new auto focus technology (old system the surgeon has to do the focus manually himself at the console)
- You can use the camera endoscope via any of the 5 ports and not just limited to the umbilical port. Surgeon can now visualise the anatomy from multiple angles if needed.
- This makes it possible to release abdominal adhesions safely with greater ease compared to the older model (Especially in patients who had previous abdominal surgery).
- Change camera lens angle from 30 degrees up or down by the surgeon pressing a button at the console. In the old system you have to remove the camera each time from the abdomen and the assistant have to manually change it every time by hand. This can be very time consuming. The ease to change the angle to 30 degrees up makes it possible for Dr Moolman to do a better nerve sparing procedure as he does a complete posterior release of the nerve bundles.
- “Firefly" fluorescence imaging. New infrared technology that allows the endoscope to trigger injected dye to fluoresce. This is used to visualise blood vessels and tissue perfusion that is not visible with the naked eye. This will assist the surgeon to detect blood vessel anatomy in great detail, reducing risk of blood vessel injuries and blood loss. Tissue perfusion is helpful with partial nephrectomies in kidney cancer to see if the area of the kidney (where the tumour is going to be removed from) is not perfused after selective clamping of a renal artery branch to ensure a bloodless field during surgery. Also used to show good perfusion of the kidney after releasing the artery clamp.
- The surgeon can take photos of any part of the procedure with touch of a button on the console. There is no such function on other da Vinci models.
- The technology also includes an integrated “GPS” system to assist the surgeon in controlling instruments not in their view. The da Vinci X has new improved safety specifications that reduce the risk of any complications during the surgical procedure.
5How Long Is The Hospital Stay with Robotic Surgery?
1-2 days. Two thirds of Dr Moolman’s patients go home the next day after surgery.
6Will There Be Any Pain?
Because robotic surgery requires only a few small incisions, the post-operative pain is significantly less than after open surgery. Pain is well controlled the first couple of days with oral pain medication.
7Will I be incontinent of urine after my robotic prostate surgery?
There is never complete urine incontinence after robotic prostatectomy. Rather, the short-term incontinence experienced by men is more of a slight drip or leak. You might have to wear an incontinence pad or two during the day usually for the first couple of weeks. This incontinence might happen during strenuous activity, and could even occur when you sneeze, cough, or laugh. Patients who experienced normal continence prior to surgery should regain function within a couple of weeks to months of their surgery.
Dr. Moolman’s results show complete urine continence (no pads) of 95% at 3-6 months after the surgery.The chances of permanent urine incontinence is 1-2%
8What can I do to improve my urine continence?
You will start doing pelvic floor exercises prior to and after your surgery to prevent incontinence. You will also see a physiotherapist during this time to expedite your recovery.
9Will I still be able to be sexually active after my robotic prostate surgery?
Yes, if you are a candidate for a nerve sparing procedure. In healthy men with good erectile function prior to surgery, the recovery might take up to a couple of months. PDE5 inhibitors (Viagra/Cialis/Levitra) work very well during this recovery period. The risks for erectile dysfunction are different from person to person but will be discussed by Dr. Moolman on an individual basis.
10How long will the catheter stay in?
5 days. Dr. Moolman will take your catheter out and then discuss your histology report from the pathologist.
11How do I know the cancer is all removed after robotic prostatectomy?
If the pathologist report shows the tumour margins was negative (cancer was contained in specimen and did not stretch the edge of the specimen) and your PSA at 6 weeks post operation is undetectable.You will have follow up PSA blood test very 3 months for the first 1 year.
12How long before I can go back to work?
You need at least 7-10 days off at home. You will be able to walk around and work on your laptop from the day after your surgery.
13How long before I can play sport?
You will be able to walk around your neighbourhood or park from the day you get discharged from hospital. You may not participate in heavy lifting or strenuous activities for 3-4 weeks.Low impact sport like hiking, swimming, stationary bicycle is allowed from 2-3 weeks.
14How long before I can drive?
It will take 3 weeks before you can drive yourself again, thus your partner will have to drive you or you will need to get a driver.