Treatment

The Da Vinci Surgical robot was introduced to Tauranga through a joint venture between Grace Hospital and Urologists practicing within the central North Island. Robotic assisted surgery was first performed at Grace Hospital in November 2007 by surgeon Peter Gilling. The introduction of robotic assisted surgery has ensured our patients have access to the latest advances in laparoscopic technology.

A robotic assisted laparoscopic radical prostatectomy is the removal of the entire prostate gland using advanced robot technology.

Procedure Profile

• The surgery begins with the surgeon making five small incisions for the camera and robotic instruments. The abdomen is filled with gas (carbon dioxide) separating the tissues to allow better vision during surgery.
• The camera is passed through one of the incisions followed by placement of the remaining surgical instruments under direct vision of the camera.
• Once the surgeon is satisfied with the port placement, he commences the operation remotely from the console located in the operating theatre.
• The robotic system allows the surgeon's hands to be translated into precise movements of micro-instruments while operating. It also gives the surgeon a 3D image of the operation which helps to identify important anatomical structures more definitively that the usual laparoscopic surgery.
• Theatre staff are at your side throughout the entire surgery assisting with the procedure.
• The robotic system cannot be programmed, nor can it operate on it's own. It can only make its movements on direct input from the surgeon.

Pre-assessment usually takes place 1-2 weeks before the date of surgery. During this appointment the pre-assessment nurse will go through your medical history, any current medications your taking and conduct some routine examinations such as an ECG and blood pressure readings. You will be given details of any medication required before your surgery and when this should be taken. The nurse will tell you when you should use the microlax enema.

If you live outside the greater Tauranga area, a phone consultation with the pre-assesement nurse can be arranged. However, if you do have a significant medical history you may be requested to come to Grace Hospital a day or two before your surgery date to be fully assessed.

Your Consent

We need your permission for your operation to go ahead. Before you sign the consent form it is important that you understand the risks and effects of the operation and anaesthetic. These will be discussed in full with you during your consultation with  Peter Gilling.  Should you have any questions following this consult, please contact the team at Urology Bay Of Plenty who can answer them.

About Your Anaesthetic

If you have a significant medical history you may be seen by the anaesthetist who will conduct an assessment.

You will NOT be allowed to eat or drink anything for at least six hours before your surgery. This includes chewing gum and sweets.

The type of anaesthetic used for this surgery is:

• General Anaesthetic: You will be asleep throughout the operation and remember nothing of it.

You will discuss this, and your questions with the anaesthetist.

You must not drive any vehicle or operate any machinery for 24 hours after having an anaesthetic. You will have to arrange for someone to drive you home if you go home within 24 hours of your surgery.

Your Operation

You will need to arrive at Grace Hospital at the time given to you at your pre-assessment appointment. The reception staff will show you through to the pre-op suite. From here you will be taken through to the changing rooms where you will get into your theatre gown and be fitted with compression stockings. The stockings are used to reduce the risk of developing blood clots.

At this point you will be seen by the anaesthetist and surgeon.

Your family is able to stay with you through the entire time.

You will be shown to through to the operating theatre where the surgical team will take over. Your procedure will take approximately 3 hours.

After Surgery

You will wake up in the recovery room where the recovery staff will look after you initially. Once you are awake and comfortable you will be transferred to the ward. A urinary catheter will have been inserted to drain your bladder over the next 7 days. A small tube is inserted on the right side of your lower abdomen to drain any excess blood.

Once you have been moved to the ward your family will be contacted and they may come in and visit you. You may feel very sleepy for a few hours after surgery so you wont be a great conversationalist.

The theatre nurses will have applied an Oxytrol patch to your left flank. This is to help prevent bladder spasms which are caused by the bladder being irritated by the catheter and/or surgery.

In the first four hours on the wards the nurses monitor your blood pressure, temperature and pulse every half hour. They administer pain relief as needed and you will be given small amounts of fluid. If this is tolerated you may be allowed something light to eat later in the afternoon or evening of your surgery. This aids your recovery and reduces the risk of developing respiratory infections and blood clots.

The morning after surgery you will be seen by your surgeon and anaesthetist and your drain removed. You should be able to have a shower and move around the ward. The Continence Nurse visits during this time to educate you on how to manage your catheter while at home. She will also provide some additional supplies.

Going Home

Some local patients will be discharged if they are feeling comfortable. If you are from out of town or prefer to stay another day you can expect to be discharged the following morning around 10 am. The ward nurse will give you an appointment time to have the catheter removed, usually a week from your surgery date. If you are from out of town and are not planning on staying in Tauranga for the week, you can arrange for your local urology clinic, district nurse or GP practice to remove the catheter.

Driving is not allowed for 48 hours after surgery. Always use pain as your guide to your level of activity.

Once Home

All strenuous exercise and activity should be avoided for the first two weeks, including running, lifting heavy objects, cycling, gym activities and golf.

Seeing blood in the urine is very common after a RALP. It is important to avoid straining to have a bowel movement as this puts pressure on the newly healing internal wounds. Its is recommended that you take Senokot tablets (available over the counter from any pharmacy) for a week or two, until you resume normal activity.

Some patients experience pain in the perineum, the area between the scrotum and the anus. This pain may be worsened when sitting on firm surfaces. this usually resolves within a few weeks but anti-inflammatory drugs, such as Ibuprofen, often help.

Catheter Removal

The majority of patients have their catheter removed  7 days after surgery.  This is usually done at our rooms and you can expect to be at this appointment for up to 2 hours. The catheter removal itself, only takes a few seconds but you need to drink plenty of fluid afterward and the nurse will want you to pass urine a few times before leaving the hospital.

Very occasionally a patient may be unable to pass urine and a catheter may be re-inserted for a short period.

While you are in hospital, we will do everything we can to make your stay as comfortable as possible. The nursing and medical staff are always available to help with whatever needs you have. If you are worried about anything before or after your surgery, or if you have any further questions or would like more information, please do not hesitate to ask your nurse who will be more than happy to help.