Surgery considerations

Wheel

I posted this initially right after my surgery, but I know many new members come on and don’t see an older post. This post is currently for all the viewers on the site recently diagnosed and considering Surgery as an option but have not yet had one or two consultation’s with Surgeons. Here is what I gave learned are some important factors to consider in choosing your Surgeon during consultation’s. This being said the technologies and techniques advance quickly in the field. Just because your surgeon is not using the latest DaVinci Robotic model does not change his expertise in the field or his ability in performing an outstanding surgery. Also even if a Surgeon wanted to do a nerve sparring it might not be possible, or just one side. These are some questions you could bring up in your consultation.

The number of Robotic Laparoscopic Radical prostatectomy’s he performs.

Whether he uses a DaVinci Robotic single port (latest) one incision for entry or makes the 3 to 6 incision entries using the older DaVinci. There are reasons surgeons prefer one approach over the other and the needs of the patient.Thesingle port leaves barely a scar, I can hardly see 18 months post surgery. In addition, not necessarily an overnight stay in the hospital. I went home the same day as my surgery.

Whether he performs nerve sparring.

Whether during surgery while you are on the table he will send the sliced prostate bed tissue and lymph nodes immediately to Pathology for inking and staining to rule out whether the cancer has left the capsule even if the PET says it had not entered the bed or lymph nodes and is localized to the capsule. Then if pathology reports positive margin in the bed the Surgeon can go back in deeper while your are on the table to try to eliminate the positive margin.


Whether he leaves intact and does not cut the puboprostatic ligament to maintain urethral length which improves the likelihood of minimal if any post leaking by allowing more control in the release of urine and maintains the urethra more in its position. I was immediately continent and you don’t see a shrinking of your penis size by not cutting the ligament which is less pulling up the urethra to reattach to the bladder because the bladder remained taunt in place without the ligament cut which causes this shrinking of your penis by pulling them back together for reattaching. This is a Retzius sparing technique in the actual surgery where the surgeon accesses the bladder from behind the prostate allowing the ligament not to be cut, and takes a skilled surgeon in this technique. You are positioned differently then in a normal robotic prostatectomy because of coming in reverse. Sexually I have returned normally but need Viagra 90 minutes before which was never needed. I had my surgery at 71

I thought this might be helpful to repost.

Wheel

In addition I should add my Surgeon had no reason to believe I had positive margins, the PET was negative and having done hundreds, through his observation nothing looked astray in tissue, and he was totally surprised when pathology came back positive, but then he was able to continue my surgery 2 additional hours carefully removing move margin, and then in my post op visit I was informed final pathology was negative margins. Now if he did not send to pathology while I was on the table, I would have been informed unfortunately about positive margins and looking at additional treatment of Radiation.

Clevelandguy

Hi,

Thank you for posting, the one incision way seems a good path to follow.

Dave 3+4

Wheel

Dave, it is really hard to believe when I look at the incision site, it does not even look like a scar and I can’t believe they did surgery at that site.

Steve1961

I know everyone’s different. Maybe I’m just lucky. I I had five incisions or and I look in the mirror. I can’t see any of them. None gone.

Marlon

I think your observations confirm what I have told other people: they don't really know what's going on until they get in there.