About the Procedure:

Since August 2002, physicians at Urology Centers of Alabama have been performing robotic laparoscopic prostatectomies. Dr. Scott Tully, Dr. Charles E. Bugg and Dr. Vincent Michael Bivins are performing the surgery at St. Vincent’s and Trinity Hospitals in Birmingham, Alabama.

With the state-of-the-art daVinci system, the surgeon uses a three-dimensional computer vision system to manipulate robotic arms. These robotic arms hold special surgical instruments that are inserted into the abdomen through small incisions. A laparoscope, which is a lighted telescope, is inserted through one incision and then connected to the computer monitor that will allow the surgeon to look inside the body.

The three-dimensional view helps the surgeon easily find the nerves and muscles around the prostate. The robotic arms can rotate a full 360 degrees, allowing the surgeon to manipulate surgical instruments with flexibility. The surgeon can perform the same nerve-sparing procedure as done in a conventional laparoscopic prostatectomy. The prostate, lymph nodes, seminal vesicles and surrounding tissue are removed through the small incisions, which are later closed with small stitches.

With the robotic procedure the recovery period is more rapid and most patients can go home within 24 hours and can return to normal activities within one to two weeks following surgery. Patients have stated that they have very little pain and are able to walk the evening of surgery.

Comparing Robotic vs. Open:

Patients have told us they are most concerned about several factors when making their decision on what type of prostate cancer treatment they choose.

• Cancer Removal
• Potency
• Continence
• Blood Loss
• Pain
• Safety

Cancer Removal

Surgeons measure their success in eliminating cancer from the body by looking at the surgical margins -or the edges of tissue on the removed prostate. A pathologist will look at the removed prostate under a microscope, and if he sees cancer on the edge, this is called a positive margin.

Whether a cancer can be removed completely depends on two factors, the skill of the physician and how bad the cancer is. No matter how good a surgeon is, he will not be successful in removing all the cancer if it is aggressive. Pathologists relate the aggressiveness of prostate cancer to tumor volume (how much cancer there is) and to tumor grade (how abnormal the cancer looks under the microscope)

If the cancer is completely removed, the PSA score should be undetectable.

Continence at Six Months:

When the prostate is completely removed, one of two muscles, the bladder neck smooth muscle that controls urination, is removed as this muscle lives in the prostate. The second muscle is able to control the urination in most cases. This will take time.

For patients having the robotic prostatectomy, 94% are not wearing pads at six months.

First Appointment & Scheduling Information:

If you have been diagnosed with prostate cancer, our robotic surgeons are available for consultation.

You can call (205) 930-0920 or (800) 452-1464 to make an appointment. It is requested at the time of consultation that you have the following information available:

• PSA level prior to biopsy
• Pathology report
• Updated medical history
• Current medications
• Any additional tests obtained after biopsy such as Cat scan or bone scans

Pre-Op Instructions:

You must get medical clearance from your primary care physician or cardiologist prior to surgery. Please have your physician fax medical clearance to the robotic surgery scheduler at fax number 205-445-0150

TWO WEEKS PRIOR TO SURGERY: Stop all medications listed below (check with your doctor before stopping these medications):

 

Advil	Excedrin	Nuprin
Anacin	Feldene	Relefin
Anaprox	Goody BC	Stanback
Aspirin	Ibuprofen	Vitamin E
Bufferin	Indocin	Voltaren
Clinoril	Midol
Coumadin	Motrin
Darvocet ASA	Naprosyn
Ecotrin	NSAID's

 

Please do not take PLAVIX at least three weeks prior to surgery.

• Lab work cannot be done more than 14 days prior to your surgery date.
• Be sure and notify your surgeon if you are on any types of blood thinning medications (Coumadin, aspirin or Plavix).
• Stop all multivitamins or herbal supplements two weeks prior to the procedure.

If you have any questions, you may call the robotic surgery scheduler at 205-445-0177.

INSTRUCTIONS FOR THE DAY PRIOR TO SURGERY:

1. Clear liquids all day, no solid foods (clear liquids also includes popsicles, Jell-O and chicken broth)
2. Take all of your normal medicines except those containing aspirin, Coumadin, vitamin E or other blood thinners.
3. Bowel preparation:

• 6:00 p.m. - Fleet’s enema

This can be purchased at your local pharmacy.
Nothing to eat or drink after midnight.

For any questions please call 205-445-0177.

Post-Op Instructions:

Questions and answers about post-op:

Q: How long can I plan on being in the hospital after the procedure?

A: Normally, 98% of the patients are able to go home the day after the surgery.

Q: After the surgery will I be able to resume my normal activities?

A: The major advantage of the robotic procedure is decreased bleeding and decreased pain, which results in an easier recuperation period. Most patients undergoing this procedure will be able to resume normal activities within one to two weeks. However, each individual heals differently.

Q: After the surgery, when will I have complete urinary control?

A: While some patients regain control more quickly, most men require a period of time before their control returns. By three months after surgery, 94% of men are using 0-1 pad per day.

Q: Following surgery, will I be able to have sexual relations?

A: The return of erections after surgery is usually slower than the return of urinary control. The average time until recovery of erections is 6 to 18 months, and it can improve for as long as 2 to 3 years after the operation. However, each patient is different. While patients are waiting for the return of erections that are spontaneously firm enough for vaginal penetration, several methods can be used to help induce and improve erections. These include oral drugs (Viagra, Levitra, or Cialis), penile injections, vacuum erection devices, and urethral suppositories (such as Muse).

Q: How long can I expect to be off work?

A: This varies with each individual. Some patients return to light work as early as two weeks after surgery; however, recovery times vary from individual to individual as do work requirements. In some cases, you may be authorized for medical leave for up to six weeks.

St. Vincent’s Hospital Information:

St. Vincent’s Hospital, the oldest hospital in Birmingham, is a not-for-profit hospital that has been dedicated to the betterment of health in Birmingham for more than a century. Founded by the Daughters of Charity of St. Vincent’s DePaul in 1898, this Catholic health care facility is a member of Ascension Health Corporation.

Why Choose Robotics?:

Studies of several thousand patients show that laparoscopic surgery is as effective as an open prostatectomy with less post-operative pain, fewer complications, shorter hospital stay and a faster recovery time.

Compared to open surgery, robotic laparoscopic radical prostatectomies offer:

• Less Pain
• Fewer Complications
• Shorter Hospital Stay
• Faster Recovery
• Earlier return of urinary control
• Improved sexual function
• Less internal scarring

Score Card & Explanation:

Procedure

• Average operative time: 2-3 hours
• Average blood loss: less than 100 cc
• No mortality or re-exploration
• 95% discharged in one day
• Average hematocrit of 34.5 (preoperative/postoperative change of 3.1 points)
• Average catheter time: 7 days

Oncology

• Positive margin rates of 10.5% for the first 200, 7.7% for the first 350, and slightly less than 5% positive margin rates for the last 100 patients using intraoperative frozen section techniques.
• Excellent tumor control with 95% having an undetectable PSA in one year.

Functional results

• 27% with immediate continence requiring no pads; 47% in one month, 82% in three months, 94% in six months, and 98% in one year of continence without pads.
• Potency data is pending but when nerve-sparing procedures are performed, the results have been very promising.
• Back to normal activities in 9-10 days per third party questionnaire.

Trinity Medical Center Information:

Trinity Medical Center (formerly Montclair Baptist Medical Center) located in east Birmingham was established in 1966 as a replacement facility for the Highland Avenue Baptist Hospital. Today Trinity Medical Center is a 560-bed facility offering programs and services in all medical and surgical areas. This includes cardiology, oncology, neurology, women’s health, mental health, digestive diseases, geriatrics, physical medicine and rehab, sports medicine and emergency care. More than 600 physicians are members of the Trinity medical staff. There are over 1,800 employees (full time and part time).

For more information, please call 1-877-TMC-1232.