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da Vinci Robotic Suprapubic Prostatectomy (dv SPP) is a minimally invasive form of surgically removing the inside of the prostate gland to treat benign (non-cancerous) prostate enlargement. This treatment does not treat prostate cancer as the outside part of the prostate is left in place. Leaving the outside part of the prostate intact eliminates the risks of stress incontinence and erectile dysfunction associated with Radical Prostatectomy for prostate cancer. However, leaving the outside part of the prostate in place also means that it is still possible to get prostate cancer following dV SPP and so future prostate cancer screening may be necessary. This approach is generally used for prostate glands larger than 80 grams. For glands smaller than 80 grams, KTP Laser Prostatectomy (see our patient brochure on KTP Lasers) is usually applied. dV SPP is far less invasive than Open Suprapubic Prostatectomy but more invasive than KTP Laser Prostatectomy.
dV SPP is performed through 6 small port holes instead of an incision. This technology greatly minimizes blood loss so that there is a very low risk of blood transfusion and it decreases the risk of possible injury to the urinary bladder so the urinary catheter can be removed more quickly (one week) and there is usually no need for extra tubes or drains that are required for open suprapubic prostatectomy. Healing and return to your regular activities is greatly accelerated by the robotic approach.
For the dV SPP you will be admitted to the hospital the day of surgery and can expect to go home the next day or 2 days after surgery with a catheter through the penis to drain your bladder. This catheter will be removed in the office one week following the surgery.
DVT (Deep venous thrombosis, or blood clots in the veins of the legs) and even pulmonary embolism are a risk of pelvic surgery so you will be started on a blood thinner, Lovenox, the evening of the surgery. This medication is delivered subcutaneously with a needle just below the skin. You will remain on this medication while in the hospital and then you should begin taking an aspirin a day once you get home to thin the blood one month. You can also help to prevent blood clots by moving your legs. The clots form in the veins of the legs when you are not creating muscle movement and the blood sits in the veins not moving. Moving the legs compresses the veins and keeps the blood moving. Walking and knee bending help keep the blood in the legs moving to prevent blood clots. You should get up walking as early post op as possible; start the evening of surgery with the help of your nurse if you are able.
Following the removal of the catheter you can slowly begin to resume your usual nonstrenuous 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. Nonstrenuous activity may increase these pains but will not injure the healing process. You can resume your usual strenuous activities after four weeks 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)
Bowel Movements may be difficult after surgery during the first week or two during your recovery. We recommend that you increase fruit and fruit juices or over the counter products such as Colace or Dulcolax or Magnesium Citrate and/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. We also recommend that you continue on a liquid diet the first few days at home (soups and jell-o are fine) until you have your first bowel movement. If you decide to enjoy some solid food during this time you should do so in small quantities.
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 band aids that should stay in place until one week after the surgery. These band aids have, in turn, been covered with a gauze sponge and a transparent tegaderm dressing. This tegaderm and gauze should be removed two days after 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 four weeks after surgery, you should not engage in heavy lifting or contact sports or very vigorous activity. After four 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.
