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The Robotic Simple Prostatectomy by Dr. Bevan Thomas
The Robotic-assisted simple prostatectomy (RASP) performed by Dr. Bevan-Thomas is an effective solution for men with significantly enlarged prostates who suffer from BPH issues. This advanced procedure utilizes the DaVinci robotic technology to remove obstructing prostate tissue while minimizing the risk of incontinence and erectile dysfunction. Let’s dig deeper into understanding this approach for men with larger prostates.
The Robotic Simple Prostatectomy: Size matters
Once men have been diagnosed with symptomatic BPH and require an intervention, the next step is to evaluate the anatomy of the prostate. The average prostate for a man in his 60s is roughly 40 to 50 grams, which is the size of an apricot; however, as men age, the prostate continues to increase in size.
Some prostates will grow at a faster rate than others, depending on the genetic makeup of the man and his prostate. Most prostates larger than 100 grams (similar to the size of a Kiwifruit) are considered larger prostates. FYI – yes, it should be called Kiwifruit, not Kiwi, as that is a bird (thanks Google).While many procedures are available for men with smaller to medium-sized prostates, larger prostates create a problem for Urologists. The traditional TURP or even greenlight laser takes more time to remove in surgery, and the patient’s risks routinely increase with surgery time. The major risks include the absorption of fluid into the bloodstream, bleeding, and the inability to remove enough prostate tissue to improve a patient’s BPH issues.
Benefits of the Robotic Simple Prostatectomy for BPH
⦁ Patients undergoing robotic simple prostatectomy experience a significantly decreased risk of blood loss and reduced operation time compared to traditional open surgery, contributing to a safer surgical experience. In these cases, the use of a catheter can also improve recovery.
⦁ Preservation of urinary continence and sexual function: This approach offers improved preservation of both urinary continence and sexual function following the catheter procedure, enhancing patients’ overall quality of life. Because only the inner aspect of the prostate is removed, the nerves responsible for erections and the major muscle controlling urinary continence are located away from the surgery and are protected. Read below about the Orange peel analogy to learn more.
⦁ Immediate improvement of urinary flow. Patients routinely require a catheter 5-7 days after the procedure to allow the bladder to heal. Immediately after the catheter removal, most men notice an immediate improvement in their urinary flow.
The Orange analogy
The robotic simple prostatectomy can be compared to the delicate task of scooping out the inner part of an orange while leaving its peel intact. To simplify, the prostate has an inner part and an outer layer similar to an orange. Utilizing the daVinci Robotic surgery platform, Dr. Bevan-Thomas removes the enlarged inner section of the prostate gland, akin to extracting the juicy fruit segments of the orange without damaging its outer skin. This is particularly important because the nerves responsible for erections and the muscle most helpful in preventing urinary leakage are on the outside of the prostate, thus minimizing these complications after this surgery. Keep reading for a more in-depth look at the actual surgery.
Steps for the Robotic-assisted Simple Prostatectomy
Here’s a simplified description of how Dr. Bevan-Thomas performs this surgery:
Preparation and Anesthesia: The procedure begins with the patient being placed under general anesthesia, ensuring they are asleep and pain-free throughout the operation. Dr. Bevan-Thomas and the surgical team then position the patient to allow optimal access to the prostate gland.
Setting up the Robotic System: Dr. Bevan-Thomas utilizes the daVinci Robotic surgical system, which includes a console where he operates, robotic arms that attach remotely to the console, and a high-definition 3D HD camera. This camera provides an enlarged, detailed view of the prostate and surrounding areas, aiding in precision.
Incisions and Robotic Assistance: Dr. Bevan-Thomas makes a few small incisions in the patient’s lower abdomen. He then inserts the robotic arms equipped with the necessary surgical tools. Sitting at the console, Dr. Bevan-Thomas controls these arms, translating his hand movements into precise, delicate movements of the robotic instruments inside the patient.
Prostate Removal: The crucial part of the surgery involves carefully separating the enlarged inner portion of the prostate from the outer aspect of the prostate. His expertise, combined with the robotic system’s precision, allows for the targeted removal of problematic tissue while minimizing harm to adjacent nerves and muscles.
Closing the Incisions: After successfully removing the enlarged prostate tissue, Dr. Bevan-Thomas closes the incisions using sutures. The robotic system’s precision often results in smaller incisions, which can lead to less scarring and quicker healing. Absorbable sutures and glue are routinely used for the skin.
Minimized Tissue Damage
One of the key benefits of the transvesical approach is its ability to minimize damage to surrounding tissue.
⦁ By directly accessing the prostate through the bladder, this technique reduces trauma to critical structures such as nerves, muscles, and blood vessels on the outside of the prostate.
⦁ Minimizing tissue damage can contribute to faster postoperative recovery and reduced risk of complications for patients undergoing robotic simple prostatectomy (RASP).
Bladder Stones
One of the problems with an enlarged prostate is the inability to empty the bladder. Bladder stones often emerge as a complication in men with benign prostatic hyperplasia (BPH) and are even more common in men with larger prostates.
In BPH, the enlarged prostate partially blocks the urethra, leading to difficulties in fully emptying the bladder. This retention of urine creates an ideal environment for bladder stones to form. These stones are crystallized accumulations of minerals in urine, similar to rock candy but not so sweet. When the bladder does not empty, these minerals can concentrate and solidify into stones.
In the context of BPH, bladder stones can intensify urinary symptoms, such as discomfort and increased risk of infections, and exacerbate urinary retention. Addressing bladder stones and the underlying BPH is essential to restore proper urinary function and alleviate symptoms.
Recovery After Robotic Simple Prostatectomy
Recovery Time
While there is a learning curve associated with robotic surgery, institutions offering this surgical procedure have reported positive outcomes within minutes using a camera inside the body to navigate and remove the enlarged prostate capsule in a series of carefully planned steps, making use of a catheter. Because the procedure is done laparoscopically and with the DaVinci robotic platform, men walk around within 24 hours after the surgery.
Pain
With small incisions, most men do not require pain medication after the first 24 hours. Most of the discomfort involves the catheter in the bladder, and bladder spasm medication helps significantly with this.
Limitations
⦁ No heavy lifting (greater than 15 pounds) for the first 4-6 weeks to minimize the risk of developing a hernia
⦁ Start slowly with your diet. Dr. Bevan-Thomas recommends that patients not start eating solid food until they pass gas and then begin eating half of what they usually eat for the next few days. It can take a few days for the bowels to wake up after abdominal surgery, and it’s not a good idea to overload the system too quickly.
Potential Short-term Issues
⦁ Blood in the urine (usually only blood-tinged)
⦁ Temporary difficulty urinating. (Very Rare)
⦁ Mild discomfort, which typically resolves over time.
⦁ Draining from the port sites – should heal up spontaneously
⦁ Urinary urgency – the overactive bladder no longer has the prostate blocking its way to freedom, so try to ensure you are urinating every 2 hours during the daytime and refrain from drinking fluid 2 hours before going to bed
Alternative Treatment Options for Enlarged Prostate
Medications and minimally invasive procedures offer alternative treatment options for managing symptoms of an enlarged prostate.
Medications
⦁ Alpha-blockers and 5-alpha reductase inhibitors are commonly prescribed to alleviate symptoms associated with prostate enlargement.
⦁ Alpha-blockers work by relaxing the bladder neck and prostate muscles, improving urine flow, and reducing symptoms such as urinary urgency.
⦁ 5-alpha reductase inhibitors help shrink the prostate gland over time by blocking the production of hormones that cause prostate tissue growth.
Minimally Invasive Procedures: Prostate Size Matters
⦁ Dr. Bevan-Thomas is an advocate for minimally invasive procedures for men with BPH; however, they are not only ineffective but also not approved for larger prostates (prostates larger than 100 g). This is why it is so critical that men know their prostate volume before they decide how to treat their BPH symptoms.
Considerations
⦁ The choice between medications or minimally invasive procedures depends on factors such as the severity of symptoms, overall health, and personal preferences. Often, the medication loses its efficacy, and men’s symptoms become progressively worse. If this happens, call Dr. Bevan-Thomas for a consult to discuss options.
⦁ Follow your symptom index score – The IPSS score is a validated questionnaire and, if answered correctly, will reasonably estimate a man’s current bladder and BPH status.
Considerations
⦁ The choice between medications or minimally invasive procedures depends on factors such as the severity of symptoms, overall health, and personal preferences. Often, the medication loses its efficacy, and men’s symptoms become progressively worse. If this happens, call Dr. Bevan-Thomas for a consult to discuss options.
⦁ Follow your symptom index score – The IPSS score is a validated questionnaire and, if answered correctly, will reasonably estimate a man’s current bladder and BPH status.
Key Factors to Consider
⦁ Severity of urinary symptoms: The degree to which urinary symptoms affect daily life can influence the choice between medication or surgical intervention.
⦁ Overall health condition: Existing medical conditions may impact treatment decisions.
⦁ Bladder Function – Unfortunately, many men leave treatment until it’s too late. If the bladder has become overstretched and no longer functions, no surgery or procedure will help. They are destined to intermittent catheterization, which requires men to place a catheter in their bladder 4-6 times a day because the function is lost. Although not typical, it is a devastating side effect of BPH and yet another reason to get checked if you are having urgency, frequency, and waking up at night to urinate.
Conclusion
In conclusion, the Robotic Simple Prostatectomy offers a minimally invasive and effective solution for individuals suffering from an enlarged prostate with urinary symptoms. The procedure, as outlined in the preceding sections, involves a laparoscopic approach with several keyhole incisions in the abdomen and has a quick recovery time. It is only suitable for patients with larger prostates, so it is paramount that you get an ultrasound or MRI to evaluate the size of your prostate. Dr. Bevan-Thomas routinely performs the prostate ultrasound in his office and, along with a cystoscopy, should have a good idea if this is the best procedure for you and your urinary symptoms .
For those seeking more information on BPH or considering a Robotic Simple Prostatectomy, leave a request below or call Dr. Bevan-Thomas’ office in Arlington, Texas.
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Why Dr. Rich Bevan-Thomas for Robotic Simple Prostatectomy?
Robotic surgery is a skillset and Dr. Rich Bevan-Thomas has been performing robotic surgery since leaving UT Houston and MD Anderson Cancer Center in 2002. He has been perfecting his robotic skills for the last 18 years, and most importantly, he will help you make the decision that is best for your condition and size of your prostate.
Although most men will not require a robotic simple/partial prostatectomy, it is in Dr. B-T’s arsenal, so whether your prostate is the size of a strawberry or the size of a grapefruit, he is willing and able to tackle your prostate issues.
If you haven’t yet met with Dr. Rich Bevan-Thomas, click the button below to make an appointment for a robotic simple prostatectomy in Arlington.
