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Prostate Cancer - Looking for people who have had the Da Vinci Surgery with Dr. Vipul Patel

Posts: 2
Joined: May 2019

Good day. After a PSA investigations, I have discovered that I have prostate cancer. I have made the following investigations:


- Fusion Biopsy in Milan, the result was 7 (positive)

- A PET Colina Test which could not reveal the areas of the disease, only a bit in the adenopathy area of the pelvis.


I am 52 years old and I would like to minimize any complications whilst preventing any impotence and incontinence. After personal research, I have discovered that Dr. Vipul Patel seems to be the go-to surgeon for the robotic surgery with Da Vinci, which is supposed to be minimally invasive and nerve-sparring which sounds exactly like what I need.


If there are people out there that have had this surgery and would be up to give me advice to point me in the right direction, I would be grateful. Thanks.

Posts: 158
Joined: Jun 2016

In my case, nerve sparring surgery was meaningless.

It left me 100 % with ED which I never recovered to the point of any functionality.

Was 51 y/o at time of surgery and with no other medical problems, very healthy with no signs of ED before RP and also physically very fit.




lighterwood67's picture
Posts: 159
Joined: Feb 2018
I would not call this surgery minimally invasive.  I am assuming you have a Radiologist Onocologist.  
What do they say? You need to be asking a lot more questions. Side effects from surgery pretty much urethra shortening;incontinence; erectile dsyfunction. Below is my surgical procedure.
They basically have to go through your core to get to the gland; seminal vesicles, and lymph nodes.

The patient was taken to the operating room where he was placed under general anesthesia in the supine position. He was then placed in low lithotomy position, prepped and draped in the usual manner for a robotically-assisted radical prostatectomy.
The abdomen was entered through a periumbilical incision and a double balloon 12 mm port was placed here. The abdomen was insufflated. The other five port sites were marked off and placed under direct laparoscopic vision.
The robot was docked and the procedure was begun from the console.
We began the procedure by releasing large bowel adhesions on the left side of the
abdomen.  This was done with cold sharp dissection.  The space of Retzius was then
developed by dividing the median umbilical ligaments bilaterally as well as the
urachus.  Both vas were divided as they entered through the internal ring.  Once the
space of Retzius was fully developed, the endopelvic fascia was opened close to the
prostate. The dorsal vein complex was suture ligated with 0 Vicryl over the base
of the gland and then divided with the bipolar cautery over the bladder neck.
A bilateral pelvic lymph node dissection was then done (obturator and hypogastric)
including deep pelvic nodes on the left side. All longitudinal lymphatics were
clipped or sealed.
Bladder neck was dissected out anatomically and divided. We went wide anteriorly and
obtained a negative frozen section here.
Seminal vesicles and vas deferens were then identified, mobilized, dissected up and
elevated.  Denonvilliers fascia was then opened posteriorly and I dissected between
the layers of Denonvilliers fascia all the way to the apex.  The vascular pedicles
to the prostate were taken with the ENSEAL device and large clips as we got close to
 the neurovascular bundles.  The bundles were well preserved bilaterally.  Small
metal clips were used as we worked under the posterior aspect of the prostate.  An
element of high lateral release was done, but I was not aggressive about getting too
close to this capsule. I specifically went wide at the left apex to avoid capsular
incision.  As I dissected along to the apex I noted excellent neurovascular bundle
sparing bilaterally.
The dorsal vein complex was then isolated and taken with the ENSEAL device. The DVC
was oversewn with a V-lock suture. The urethra was divided with cold sharp
dissection.  The prostate was put into a specimen bag.
The anastomosis was then done in a two layer fashion using a Rocco suture to
approximate the urethra posteriorly.  This was a single horizontal mattress.
Continuous 3-0 Monocryl was then used employing a Quill suture to achieve a
watertight anastomosis. The bladder neck was tapered with 2-0 Vicryl. The
anastomosis was sealed with Eviseal and stented with an 18-French Foley catheter.  A
Blake drain was placed in the abdomen through the fourth arm port.  This was
secured with silk.
Marcaine was used to block all port sites.
The right-sided 15 mm port was closed at the fascial level with 2-0 Vicryl.  The
prostate was removed in its bag through the umbilical port.  The umbilical port site
was closed with continuous #1 PDS in the fascia. All skin incisions were closed with Monocryl and Dermabond.

The patient was awakened and taken to the recovery room in good condition. Estimated blood loss for the case was 100 mL. Sponge and needle counts were correct x 2. .

Posts: 2
Joined: Jun 2018

Other that that can you put that in a way it can be understood. But I do agree with you that there is nothing minimally invasive about this operation. 

Georges Calvez
Posts: 171
Joined: Sep 2018

Hi there,

This is not trivial surgery.
About 95% will recover something close to complete continence after one year, the rest will leak somewhere between lightly and badly enough to need further surgical intervention.
For men in their fifties recovering the ability to have an erection is about 60%, older men do a lot worse.
Some men can have OK orgasms after the event, some others just have non events.
It can be a good answer to a difficult situation but it is not without it's problems and downsides.

Best wishes,


lighterwood67's picture
Posts: 159
Joined: Feb 2018

If I were you, at your age, I would go and see a Radiologist Onocologist and see what they say.  Also, you need to know if in their opinion is the cancer contained locally to the prostate?  I am 68; Gleason 4+3=7; RARP 3/20/2018.  I am fully continent;  I am about 75% recovered from ED isuues.  My PSA at this time is undetectable.  My decision was based on what the doctors told me (Radiologist and Surgeon).  I elected surgery based on their recommendation.  In retrospect, surgery is permanent.  You probably need to be a little more forthcoming in the data you are providing (history of PSA; Gleason; DRE results, any other health issues).  The final decision comes down to you.  If you are leaning towards the surgery or RT; HT you need to make sure you get in the best shape that you can possibly be in.

Posts: 2
Joined: May 2019

I just had this surgery three months ago and it was apiece of cakesix small incienses over night in the hospital two weeks of recover at home then back to work.I had the surgery because I had agleason score of 9  and my doctor said that I tried radiation and it didnot work that it would be very very hard to remove the prostate then the doctors found a tumor on my kidney so if it has to come this will be the only type of operation I would ever consider

Posts: 2
Joined: May 2019

Thank you for all your responses and for your wishes. I would like to apologize for mistyping my age, it's actually 48. The last PSA score was 9.46, the Gleason score was 3+4. There is no cancer growth outside of the prostate as far as the doctors could tell, the biopsy has been given. I also have a few ganglions outside of the prostate which should, supposedly, be removed as they say.  In the DRE examination, nothing was seen or felt.


I am researching continously, however it is a bit difficult to approximate my chances of success since many posts are more than 10 years old and I thought there would be some medical advancements done since that period that would increase my chances of keeping the impotence and incontinence away.


@dthehill, could you tell me what doctor you had and how you are doing recovery-wise? Thank you.

@georges calvez, thank you for more general details about this surgery, I am truly hoping for the best and that's why after hearing about this doctor I thought my best chances would be with him

@lighterwood67, no major health issues otherwise, I am trying to keep myself physically fit as well.


If not for Vipul Patel, is there anybody that can recommend me good clinics for this issue in Europe?

lighterwood67's picture
Posts: 159
Joined: Feb 2018

My doctors told me that my best option at the time was to remove the prostate, if the cancer is local and contained to the prostate.  If the cancer was not contained they would not have removed the prostate.  In fact, the surgeon biopsied a section of concern during my surgery to ensure  to him that the cancer had not escaped.  The biopsy came back negative, so he proceeded with the surgery.  My understanding was if the cancer has escaped the prostate, no need to remove the prostate.  I was quoted a 10% incontinence rate and a 33% chance of permanent erectile dysfunction.  I am 20 years older than you.  Like a lot of the folks on this site the worse part was the catheter.  I agree.  I am pretty much 100 % continent.  However, my wife and I have just started doing partner yoga.  In some positions, I feel like I could lose continence, but when I feel down there I am dry.  The ED portion is a work in progress.  I have not recovered totally from this.  I still have some pain in the lower surgery area (not constant, just sometimes).  Other than that I feel fine;  I am very active.  As far as making a decision, I have read on this site where people have analyzed until they paralyze.  The main thing is do your homework; it is your decision; know what the data is telling you.  As far as I am concerned, this site has a lot of information.  We are the results of what our medical technology has to launch against this cancer.  And believe me, we are speaking from experience.  So best of luck to you on your journey.

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