Dr. Francis J. Schanne is the only Urologist in the state of Delaware ever perform laparoscopic removal of the prostate to treat prostate cancer. Dr. Schanne was the first urologist in the state of Delaware to perform Laparoscopic Radical Prostatectomy without the da Vinci robot and is the first urologist and only certified urology proctor in Delaware to perform Laparoscopic Radical Prostatectomy using the da Vinci robot. Laparoscopic Radical Prostatectomy without the da Vinci robot and now has gone on to become the first urologist in the state of Delaware to perform Laparoscopic Radical Prostatectomy using the da Vinci robot. Using laparoscopy radical prostatectomy is performed through 5 small port holes instead of an incision. This technology greatly minimizes blood loss so that there is virtually no risk of blood transfusion and it decreases possible injury to the urinary sphincter so the urinary catheter can be removed in one week (instead of 3 weeks). The time required to regain urinary control is reduced from 3 months to zero to eight weeks. 20% of patients have complete urinary control immediately after the surgery and 90% have their urinary control back at 3 months following radical prostatectomy with the da Vinci robot. Healing and return to your regular activities is greatly accelerated by the Laparoscopic approach.

The risk of erectile dysfunction is greatly reduced using the da Vinci robot when compared to the pure laparoscopic approach without the robot and when compared to that of open radical prostatectomy. In fact, the erectile dysfunction rate with da Vinci robotic radical prostatectomy is about 30% which is very similar to the rate experienced with seed implantation and less than half the rate of erectile dysfunction when compared to that of open radical prostatectomy. For a full review of the risks associated with treating prostate cancer please see our informational brochure on treating prostate cancer.

For a full review of the risks associated with treating prostate cancer please see our informational brochure on treating prostate cancer . The risks of erectile dysfunction is greatly reduced using the da Vinci robot when compared to the pure laparoscopic approach without the robot and when compared to that of open radical prostatectomy. In fact, the erectile dysfunction rate with da Vinci robotic radical prostatectomy is about 30% which is very similar to the rate experienced with seed implantation and less than half the rate of erectile dysfunction when compared to the pure laparoscopic approach without the robot and when compared to that of open radical prostatectomy.

For the da Vinci Robotic Radical Prostatectomy you will be admitted to the hospital the day of surgery and can expect to go home the next day with a catheter through the penis to drain your bladder. This catheter will be removed in the office one week following the surgery. Some men are dry after the catheter is removed but most experience significant leakage after the catheter is removed. You should expect to be very wet after the catheter is removed. You should take measures to manage this leakage by wearing adult diapers and protecting your bed. This urinary leakage will improve rapidly for most patients but very slowly for some others. The first improvement will be experiencing longer time periods between leakage events. This can typically occur at about 1-2 weeks after the catheter is removed. After that you can expect to be dry at night while sleeping. Then you should have intermittent stress leakage (leakage with coughing and sneezing and movement) that becomes progressively easier to control. Finally, there should be a return of complete urinary control. However, some men (10-20%) will have continued, long term stress incontinence following this surgery. For those who do have complete urinary control it may happen very quickly (in several weeks or less) or very slowly (several months or more).

Following the removal of the catheter you can slowly begin to resume your activities. You may experience some aching and discomfort at the 6 port sites on your abdomen or down in the perineum (where you sit on a bicycle seat) which is where the prostate was removed. These aches and pains will slowly resolve over weeks or months. Activity may increase these pains but will not injure the healing process. Resume your usual activities in a gradual fashion (try walking before you try running, hit golf balls at the driving range before you try to play nine holes of golf, etc).

Erectile function returns very slowly for some patients following this surgery while others can sometimes experience erectile rigidity adequate for intercourse within one to three months of surgery. You should probably not expect any significant erectile activity in the first month. Most men who do recover erectile activity will experience only some early sense of stirring as if they were going to have an erection but nothing resembling an erection actually occurs. This may occur periodically through the first few months. After a few months of healing some erectile activity may begin to occur and this may improve over the first 12-14 months following surgery. Some men (about 30%) will experience some long term decrease in erectile activity following this surgery. Some men will experience no decrease in activity once healed. To a large degree your outcome for erectile activity will be better if your pre-operative erectile status (younger age, no cigarette smoking, diabetes, heart disease, preexisting erectile disease, etc) is better.

Bowel movements may be difficult after the surgery during the first week or two during your recovery. We recommend that you use increased fruit and fruit juices or over the counter products such as colace or dulcolax or magnesium citrate or milk of magnesia to ease your return to normal bowel activity. You will be started on milk of magnesia in the hospital on the day after surgery and you may want to continue on that over the counter product twice a day at home until your bowel movements are smooth and soft.

The six port sites on your abdomen have been closed with an absorbable suture so there are no sutures to be removed. These port sites are also covered with small bandaids that should stay in place until one week after the surgery. These bandaids have, in turn, been covered with a gauze sponge and a transparent tegarderm dressing.  This tegaderm and gauze should be removed two days after the surgery to let the port sites be exposed to the air. At this point, two days after the surgery, you may shower but not bathe or swim. Be sure to dry off the port sites and your catheter after showering.

While the catheter is in place you should not drive. Instead, have someone give you a ride. You may walk for short distances and climb stairs with the catheter, but refrain from heavy lifting, strenuous activity or running. Once the catheter is out, you can drive and begin increasing your activities. In the first two weeks after surgery, you should not engage in heavy lifting or contact sports or very vigorous activity. After two weeks from the surgery, you can slowly increase the intensity of your physical activity. It may be uncomfortable to sit on hard or firm surfaces (such as a bicycle or tractor seat) for several months. You may wish to obtain a foam donut from a medical equipment store for sitting.

• Perioperative Instructions - Robotic Prostatectomy