"Seven-eight months ago, I couldn’t walk up a flight of stairs. I’ve been able to take my children to Disneyland and keep up with them. That’s a big difference. It’s just a wonderful feeling."
Loma Linda University Health utilizes the da Vinci® Robotic Surgery System to provide our patients with surgeon-directed, robotic-assisted surgeries like robotic prostatectomy and robotic nephrectomy. The robotic surgery system cannot work without surgeon control, nor can it make decisions on its own. It is a technologically advanced tool that provides our surgeons with better visibility, precision and control in the operating field.
While traditional surgery requires a large incision so the surgeon's hands can fit inside the patient's abdomen, robotic surgery requires only two or three small incisions. The robotic arms and camera are positioned in these incisions, allowing all of the surgical movement to take place within the abdomen. The surgeon then has a close-up high definition view of the prostate, kidney or other urologic area and is able to guide the robotic hands to delicately move, cut and suture.
During the procedure, the surgeon sits at the nearby surgical console where he controls the robot's every movement through hand guides. The robotic arms mimic the surgeon's every movement and the rotating wrists allow the machine for a full range of motion. In the prostatectomy, the surgeon is able to plainly see and carefully remove the prostate while sparing the delicate nerves in the surrounding area. Robotic surgery represents the best technological innovation has to offer coupled with the years of experience resting in each surgeon on our team.
Advantages of Urology Robotic Surgery
Because the incision size is so small, and the robotic console allows for increased surgical precision, many prostate surgery patients experience significant advantages by choosing robotic surgery. Due to individual circumstances, these benefits may not apply to every patient. In comparison to the traditional surgical experience, robotic surgery patients usually experience:
- Shorter hospital stay
- Less pain
- Less risk of infection
- Less blood loss
- Fewer blood transfusions
- Less scarring
- Faster recovery
- Quicker return to normal daily activities
As the first hospital in the Inland Empire to introduce the state-of-the-art and minimally invasive da Vinci® Surgical System, Loma Linda University Surgical Hospital is home to the most experienced surgeons in the region and offers the highest level of expertise in whole person health care.
Our surgeons do more robotic surgeries each year than any other teaching hospital west of the Mississippi. We specialize in caring for the whole person, not just a diagnosis.
For men having robotic prostatectomy, there is also a reduced risk of incontinence and impotence.
Urologic Treatment Options
Robotic surgery can be used to treat a variety of urologic concerns. At Loma Linda University Medical Center, we offer a variety of treatment options for men with prostate cancer, enlarged prostates, renal cysts and other urologic conditions.
Prostate cancer treatment options can range from “watchful waiting” (monitoring of the tumor) to radical prostatectomy (removal of the prostate gland).
Several other options include robotic or open surgery, cryotherapy and hormone therapy along with proton beam therapy.
Robotic prostatectomies are one of the latest options for treatment of prostate cancer. Some of the benefits include:
- Less blood loss and scarring than with open surgery.
- Fewer complications, including less risk of infection.
- Reduced pain-less narcotics.
- Shorter hospitalization.
- Quicker return to normal activities.
- Reduced risk of incontinence and impotence.
Ureter or Pyeloplasty Robotic Surgery
Pyeloplasty is a surgical procedure performed to remove a blockage in the ureter, which is the muscular tube that drains urine from the kidney to the bladder. Each of the two kidneys is connected to a separate ureter. Some people are born with the blockages in the ureter, but without becoming a noticeable problem until later in life. Others blockages develop from kidney stones or scar tissue.
During pyeloplasty, an incision is made in the side of the abdomen, and the surgeon reconstructs the renal pelvis to remove the blockage. The healthy sections are then reattached to the renal pelvic tissue. In some surgeries, tubes are placed in the ureter to drain urine. If a tube is used, it can be easily removed at a doctor’s office following surgery.
If your doctor recommends surgery, you might be a candidate for a minimally invasive robotic procedure. Robot-assisted pyeloplasty at the Loma Linda University Medical Center’s Minimally Invasive Robotic Surgery Program uses the state-of-the-art da Vinci Surgical System.
Kidney Surgery and Kidney Donor Surgery
Kidney cancer is relatively resistant to non-invasive treatments like radiation and chemotherapy. As a result, the gold standard treatment for localized kidney cancer is surgery.
Kidney surgery is traditionally performed using an open approach, which requires a large abdominal incision. Another approach, conventional laparoscopy, is less invasive but limits the doctor’s precision, visualization and control compared to open surgery.
Da Vinci Surgery for kidney cancer uses the best techniques of open surgery and applies them to a robotic-assisted, minimally invasive approach.
Partial Nephrectomy (kidney)
Utilizing the precision of the robotic arms, surgeons are able to remove a small tumor from a patient's kidney without removing the entire kidney.
Bladder Cancer Surgery
A robotic radical cystectomy is the removal of the bladder, prostate, seminal vesicles and part of the vas deferens due to bladder cancer that has spread into the bladder wall or refused to respond to treatment.
For years, cystectomy was performed using a traditional open surgical procedure and therefore with more tissue and nerve damage, significant blood loss and carried a greater risk of post-op infections and complications. By comparison, the robotic-assisted laparoscopic cystectomy (also known as Da Vinci Robotic cystectomy is the newest and most effective minimally invasive bladder cancer surgical method. By offering your surgeon a high-def 3-D view, the Da Vinci Surgical Robot allows the vital muscles and nerve tissues, surrounding the operative area to be more easily identified and spared.
Urologic Cancer Treatment Begins with Your Primary Physician
In most cases, once you have been diagnosed with a urologic cancer, either prostate, kidney or bladder, your primary care physician and/or urologist will assist you with the necessary test required before your surgery. This should be done approximately four weeks before surgery. If you have any questions regarding pre-op tests, please call us at 909-558-2830.
Before Robotic Urologic Surgery
2-Weeks Before Surgery
- Pre-op testing
- Chest x-ray
- EKG electrocardiogram
- Biochem profile (electrolytes, BUN, Creatinine) blood work.
- CBC complete blood count
- PT/PTT a partial thromboplastin time, a blood test to measure how long it takes for the blood to clot.
10 Days Before Surgery
- Do not take aspirin or aspiring products for 10 days prior to your surgery date to reduce the risk of excess bleeding.
- Do not take Motrin or other non-steroidal anti inflammatory drugs for 10 days prior to surgery.
- Do not take Coumadin, Warfarin or Plavix for 10 days prior to your surgery. You need to discuss stopping of Coumadin/Warfarin/Plavix with your prescribing doctor.
- Do not take herbal remedies such as Ginseng and St. John’s Wort for 10 days before surgery.
- Additionally, Vitamin E (including multivitamins) and garlic supplements should also be stopped because they can increase the risk of bleeding during surgery
Once you have elected to have robotic urologic surgery, our team will help you every step of the way. We will guide you through the pre-op process in order to make your experience as easy as possible.
At Loma Linda University Medical Center’s Robotic and Minimally Invasive Surgery Center, our team will work with you to optimize your general health in order to achieve the best possible outcomes. Our medical team consists of many world-class specialists and we are committed to addressing all of your health needs, including general fitness, cardiovascular health, smoking cessation and weight loss.
Our research has shown that by optimizing you overall health, your urologic cancer survival rates are greatly enhanced.
Loma Linda University Medical Center accepts most insurances, please verify your insurance with both your insurance company and when you call for an appointment.
With da Vinci robotic surgery, you can expect excellent outcomes as well as:
- Faster recovery
- Shorter hospital stay
- Quicker return to daily activities
- Less pain
- Smaller scars
- Less blood loss
- Lower risk of unwanted side effects
For men having robotic prostatectomy, there is also:
- A reduced risk of incontinence and impotence
- An early return of urinary control and sexual function
- A short period of catheterization
Most patients are back to their usual activities in 2-4 weeks. Increased urination is normal. There are exercises that can be done to speed up the return of normal urination.
- Most patients spend about 1-2 hours in the post-surgical recovery unit. If an overnight stay is needed, they are transferred to our post-operative floor. We will let your family know by pager when they can see you.
- Most patients start walking within 4 hours of surgery with help from our nurses.
- At Loma Linda, urologic robotic surgery patients often leave the hospital the next day after surgery. Our team will meet with you in the morning to see when you can go home.
- Patients often feel mild to moderate bloating due to the medications used during surgery. Anti-gas medications and walking will help.
- On discharge, you will go home with a prescription for medications. If you have a problem with these medicines, please call our office.
- We will tell you when to return for a postoperative check up when you are discharged. These are usually 1-2 weeks after surgery.
- Try to stay active. You may have some discomfort or feel tired, but walking slowly will help you recover.
- Eat a healthy diet and drink lots of water to speed healing.
- Try to get plenty of sleep each night.
- Many patients stop taking pain medications in the first week after surgery, but taking them before bedtime can help keep you comfortable.
- Do not strain or lift anything over 20 pounds.
- You can drive in the first few days after surgery if you are not taking narcotic pain medications.
- Most patients can return to work in about 2 weeks. If your work involves heavy lifting or other strenuous activity, it is best to wait 6 weeks.
- In general, post surgical discomfort, nausea, and bloating should decrease each day. If pain worsens or becomes severe, fever develops, or bleeding from the incisions is noted, please call our office right away. If it is after hours the hospital operator can page a member of our on-call team.
- Your first follow-up visit will be within four to seven days after robotic surgery
- Take your medicines, as directed
- Keep all appointments
- Abstain from sexual activity for four weeks after your urologic surgery whether it be prostate, kidney or bladder.
When you get home, try walking every hour for at least 10 minutes. Within a week, slowly increase the time you are walking. By 6 weeks, you should be up to 3 or more miles a day
At first, walking outside is best. Don’t return to the treadmill for a few weeks. Also, biking, motorcycling, horseback riding, yard/field equipment are not recommended for six weeks.
What is robotic-assisted surgery?
The da Vinci® Robot Surgical System is one of the most famous robotic surgery apparatuses around the world. Commonly used for prostatectomies, the da Vinci® robot is comprised of 3 parts – a surgeon’s console, a patient-side robotic cart with four arms controlled by the surgeon and a 3D, high-definition camera. This cutting-edge technology enables the surgeon to get closer to the surgical site than the human vision allows.
Am I a candidate for robotic surgery?
Consult with your doctor to see if you are eligible for robotic surgery. Most men diagnosed with localized cancer are candidates for robotic surgery.
What is a robotic prostatectomy?
A surgical procedure using the da Vinci® Surgical System to completely remove the prostate gland when cancer is present.
What are the potential risks and complications of prostatectomy?
Patients potentially risk infection at the catheter’s exit and incision site as well as excessive bleeding, blood clots, incontinence, impotence, hernia and sterility.
How long is the robotic prostatectomy procedure?
Robotic prostatectomy typically takes about 2 to 3 hours.
Is general anesthesia required with robotic prostatectomy?
General anesthesia is required to keep patients sedated and to prevent pain during the procedure.
Do I need to have a blood transfusion with robotic prostatectomy?
No, a blood transfusion is not necessary. The estimated blood loss with robotic prostatectomy is less than 3% of the blood transfusion requirement.
Is a catheter inserted in my urethra during robotic prostatectomy?
Yes, a catheter is inserted in the urethra and is connected to a drainage bag. During the prostatectomy, the catheter is used to drain the bladder.
When is the catheter removed?
The catheter is removed typically within five to seven days following the procedure.
How long will I stay in the hospital?
Patients typically spend one night at the hospital and will be discharged the following the day if they are able to tolerate pain via controlled oral medications and have acceptable laboratory results.
What measures should be taken after discharge?
Patients should take medications as directed by your doctor while avoiding products with aspirin. Patients are advised to drink plenty of fluids and avoid vigorous exercises for six weeks. Also, the patient should gently wash the incision with mild soap and water. Furthermore, patients should keep their legs elevated when resting in bed and should avoid consuming alcohol, caffeinated drinks and spicy foods.
Will I experience urinary incontinence after robotic prostatectomy?
Patients will experience temporary urinary incontinence. Normal control of urination is regained within 6 to 8 months.
Will I still be able to have an erection following prostatectomy?
After the removal of the prostate, erectile function is typically lost. While erections may still be regained, there are other factors to consider including age, sexual function prior to and after the operation, concurrent illness, medications as well as emotional and psychological stress.
Why does a prostatectomy affect erections?
While the prostate does not affect a male’s ability to have erections, the surrounding nerves that are critical for having an erection may be damaged during prostatectomy.
What happens when nerves are not spared during prostatectomy?
There are cases in which important nerves for sexual function are removed, resulting in impotence. Erectile function, however, may be restored via nerve graft and reconstruction.
When can an erection return after prostate surgery?
Although the recovery of erectile function varies, patients regain it within one to two years after surgery. In few reported cases, erections may return in as early as 4 weeks spontaneously or with medication.
Will the quality of an erection be the same before prostatectomy?
Reportedly, 84% of men said that erectile function returned to normal about one to two years after prostatectomy. Only 13% of men claimed their erections were weaker.
Will prostatectomy affect my libido?
Prostatectomy does not affect libido. Your sex drive is primarily affected by testosterone.
When can I resume sexual activities?
You can resume physical intimacy as soon as you feel better. This potentially improves your chances of regaining erectile function much earlier. You can have sexual intercourse when erectile function is recovered within one to two years after prostatectomy. Also, there are treatments available for satisfactory sex life including Viagra and penile injection therapy.
Are nerves associated with sexual function spared during laparoscopic and robotic prostatectomy?
During laparoscopic and robotic prostatectomy, nerves associated with sexual function are spared if the cancer has not yet spread. It’s important to keep in mind that satisfactory erectile function is not guaranteed by nerve sparing because it is influenced by a wide range of factors including age, medications as well as emotional and psychological stress.
Will I be able to ejaculate after undergoing a prostatectomy?
The fluid in semen is produced by the prostate and seminal vesicles. With radical prostatectomy, the semen’s pathway is removed. As a result, you will experience a dry orgasm that lacks ejaculate.
Will I be able to orgasm after undergoing a prostatectomy?
Orgasm can still occur as long as normal sensation is intact. Because orgasm happens in the brain, you’ll still able to have an orgasm without a prostate.
Can I still produce children after prostatectomy?
Since the semen can no longer be ejaculated due to the removal of the semen pathway during radical prostatectomy, you will be sterile. If you’re planning to have children, your sperm cells may be extracted from the testes or epididymis. You may also choose to cryopreserve your sperm before the procedure.
Is traveling allowed after robotic prostatectomy?
Yes, patients may travel by car or plane in two days after the procedure.
May I resume my daily activities such as going to the gym and working out?
Patients can return to their daily activities within four weeks, however they should avoid vigorous exercises like weightlifting until six weeks after the operation.
Can I have sex after prostate removal?
Robotic prostate removal is less likely to damage the nerves that lead to erections. This helps maintain sexual function after surgery.
- Wait at least 4 weeks before having sex
- The feeling of climax does not change, but there will be no ejaculation
- The return of erectile function varies from days after surgery to up to 9-12 months
How would I know if my kidney tumor is cancerous?
Generally, most kidney tumors are cancers whereas smaller tumors are more likely to be benign. Benign kidney tumors should still be removed as they may grow over time.
Should I have a needle biopsy of the tumor prior to tumor removal surgery?
Traditionally, biopsies are rarely performed for kidney tumors due to risks of bleeding, tumor spread and false diagnosis. With improved technology, emerging evidence suggests that biopsy is safe and accurate. LLUMC offers renal biopsy for select patients. Once the tumor is removed from the body, a pathologist will formally evaluate to determine what kind of tumor it is.
Are kidney cysts cancerous?
While some kidney cysts are cancerous, most are not. If a kidney cyst appears “complex” on a CT scan, MRI or ultrasound, then it may be cancerous and will need to be removed. Simple cysts usually do not need to be treated.
Should I still have my kidney removed if my cancer has spread?
While some evidence suggests that removing the primary cancer in the kidney can extend the life of patients with metastatic kidney cancer, an evaluation needs to be made to determine how risky the surgery would be. If possible, it may be best to have a minimally invasive removal to limit recovery times.
What are the chances of curing my cancer?
Most kidney cancers are cured with surgical removal. If the cancer has spread, it may be difficult to cure. X-rays are routinely performed to monitor the spread of cancer.
How are kidney tumors removed?
Traditionally, kidney tumors were removed through open surgeries with painful and large incisions. Today, open surgeries are being replaced by minimally-invasive surgeries using robots and laparoscopes, resulting in smaller incisions, less pain and faster recovery time.
Why should I have a partial nephrectomy as opposed to a total kidney removal?
Partial nephrectomy for small tumors preserves part of the patients’ kidney while getting rid of the cancer or tumor. As a result, the patient keeps most of the kidney and often maintains better overall kidney function.
What types of questions should I ask my surgeon prior to kidney surgery?
Consider the following questions to ask your surgeon:
- Can kidney surgery be done robotically? Most kidney tumors removed robotically have the same outcomes as open surgery and results in quicker recovery times and significantly less pain.
- Can I have a robotic partial nephrectomy instead of total removal or open surgery? LLUMC staff uses robotic assistance to successfully perform partial nephrectomy for even the most complex tumors including tumors situated deep within the kidney and tumors beside crucial vessels that supply blood to the kidney.
- What formal training do your surgeons have in robotic and laparoscopic surgery? LLUMC’s Robotic and Minimally Invasive Surgeons were the first in the region to utilize robotic technology.
If you have to open up the patient, are you experienced in open kidney surgery as well?
Yes, most urologists are trained in performing open kidney surgery. LLUMC offers robotic, laparoscopic and open surgery for kidney cancer.