Robotic Radical Prostatectomy

Preparation Before a Radical Prostatectomy 

In order to prepare for the surgery, the patient should be adequately counselled to ensure that the informed consent obtained is fully understood. 

Dr Hadley’s team will liaise with his own dedicated and experienced pelvic floor physiotherapy team to enhance continence recovery after surgery.

Dr Hadley and his team then run a number of tests to ensure that the patient is fit and in good health for the surgery. These will include a thorough medical assessment (history, physical examination, investigations such as blood work, urine analysis, and various imaging scans if needed). 

If further workup is required Dr Hadley’s team will arrange this and make the final call for eligibility based on the above information. He will also ensure every patient is reviewed by his experienced pelvic floor physiotherapy team for optimal continence outcomes.

This is major surgery and the patient is advised not to eat anything for six hours before the procedure.

Operative Steps

Dr Hadley uses the latest generation Da Vinci Robot and may show the robot to the patient before the surgery in order to relieve any associated anxiety and answer any related questions. 

The surgical procedures include the following steps: 

• Anaesthetist places an IV line for various anaesthetic drug and fluid instillation and puts you to sleep to enable safe and comfortable procedure.
• Dr Hadley operates the robot next to the patient's bed and his surgical team using the surgeon console. 
• Keyhole incisions are made in the abdomen for the robotic arms and camera to allow Dr Hadley to see the internal view and perform surgery.
• Once inside, the robot arms are manipulated to move various structures and organs out of the way until the prostate gland is reached.
• The bladder is taken down to access the prostate.
• The prostate tissue is dissected in sequence and removed with vas and seminal vesicles.
• The maximal length of the urethra will be spared to help with continence.
• The bladder and urethra are joined together and a leak test is performed to ensure watertight closure.
• The robotic devices and camera are removed and the initial incisions are sutured. 
• The patient is brought out of anaesthesia and placed in post-operative care.

Robotic Radical Prostatectomy Outcomes

Dr Hadley will aim to achieve the following surgical outcomes ('Trifecta') and analyse his outcomes:

• Negative surgical margins and cancer-free status
• Continence (pad free) rates
• Potency (erection and intercourse) rates

Positive Surgical Margins

When the prostate is removed it is covered in ink to mark where the surgeon has cut. It is then examined under the microscope. If cancer cells

• Touch the ink, then this may indicate that not all of the cancer cells have been cleared and some has been left behind. This is termed a “positive margin”.
• Do not touch the ink then this is a “negative margin”.

The first aim of radical prostatectomy, before any other, is to achieve a negative margin.

If cancer has extended outside of the Prostate Gland into the adjacent tissue then the chance of a positive margin increases. However, in cases where the cancer is confined to the prostate gland, the positive margin rate is very low.

After a Radical Prostatectomy

The patient is kept in the recovery room for observation and their vitals are monitored. The patient is moved to a room in a few hours, and he can begin to take liquids.

The surgical site will be kept clean and bandages will be changed as needed. 

A drain is usually removed the next day and the patient is normally discharged within 48 hours if everything looks good.

Specific instruction for bathing will also be advised.

Until notified, driving is discouraged, along with strenuous physical activities.

Care Plan After a Radical Prostatectomy

Dr Hadley will devise a care plan for the patient for the next few months, to monitor cancer status and help improve bladder control. 

Dr Hadley will also advise follow-up visits to check the patient’s progress and his compliance with pelvic floor physiotherapy and restoration of sexual function.