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Q. Do I need to donate blood before robotic prostatectomy?
A. No, unlike some open radical prostatectomies, the need for blood transfusion is less than 1%.
Q. How do continence and potency rates compare between the open, laparoscopic, and robotic approach?
A. Currently, we are studying this question. However, other studies have shown that return of continence and potency may take up to 2 years. Dr. Hu and other surgeons who offer this procedure feel the 10x magnification of the camera lens, decreased blood loss, and fine, precise movements of the robotic instrumentation contribute to nerve sparing that is equal to or better than open surgery. Again, more study is needed to confirm this.
Q. Are there any disadvantages to robotic prostatectomy?
A. Early in a surgeon's experience, it takes time to become accustomed to relying on visual cues rather than feel or tactile sensation that is used in open surgery. Again, surgeon experience is the most important factor. Furthermore, the da Vinci robot is a tool that helps the surgeon perform the same steps that are required in open surgery.
Q. How long is the surgery?
A. The time between skin incision to skin closure is typically 2 to 3 hours
Q. How do the skin incisions compare to open surgery?
A.
Q. How often is it necessary to convert to open surgery?
A. In approximately 300 cases, Dr. Hu has observed a technical problem with the robot on one occasion. In this instance, it was necessary to complete the case laparoscopically. No conversions to open surgery have taken place in his experience.
Q. Are there any conditions that prevent me from being a candidate for robotic prostatectomy?
A. In rare instances, severe medical problems prevent patients from tolerating general anesthesia and being able to undergo robotic prostatectomy. However, previous hernia repairs, abdominal or prostate surgery are not contraindications to robotic prostatectomy.
Q. Can pelvic lymph nodes be removed with robotic prostatectomy?
A. Yes, lymph nodes are removed just like open surgery
Q. How long will I stay in the hospital?
A. Most men are discharged from the hospital less than 24 hours after surgery.
Q. Is there anything I should avoid doing when I am discharged from the hospital?
A. Men should avoid strenuous activity and use common sense: if it hurts, don't do it. Furthermore, some men are constipated after surgery due to effects of general anesthesia and transabdominal laparoscopic surgery. Dr. Hu recommends staying on a clear liquid or soft diet until the first bowel movement after surgery.
Q. How long will the urethral catheter stay in to allow the reconstructed bladder neck repair to the urethra to heal?
A. Usually 5 to 7 days.
Q. How long will it take before I return to normal activities?
A. Some men are able to play golf and return to work one week after surgery; however, others take 2 to 4 weeks to fully recover
Q. Are there other surgeries that can be performed with the robotic assisted laparoscopic approach?
A. Dr. Hu has also used the robot to remove the bladder to cure bladder cancer, or radical cystectomy. In addition, some kidney cancers can be treated with this approach.
 Q. What type of training did you have to perform robotic prostatectomy?
A. Because robotic prostatectomy was first described in 2001, many surgeons have learned this technique by observing and/or being proctored by other surgeons with more experience using the robot. Dr. Hu was fellowship trained at City of Hope Cancer Center, which Businessweek cited as one the leading centers for robotic prostatectomy in 2004. He performed approximately 300 robotic prostatectomies and 10 robotic cystoprostatectomies for bladder cancer during his fellowship. Furthermore, Dr. Hu was a visiting lecturer in Taiwan where he demonstrated robotic prostatectomy and laparoscopic radical prostatectomy to Taiwanese urologists at Triservices General Hospital, MacKay Memorial Hospital, and Taipei City Hospital.
Q. How many robotic prostatectomies have you performed?
A. A study performed by Dr. Hu showed that for open radical prostatectomy, surgeons performing less than 40 open prostatectomies a year had a complication rate 2 times greater than surgeons performing more than 40 prostatectomies a year. In addition, another study recently showed that after radical prostatectomy, prostate cancer is less likely to recur in hospitals performing a high volume of surgeries. While Dr. Hu and others are presently gathering data to answer this question for robotic assisted laparoscopic radical prostatectomy, another study showed more than 250 cases were necessary just to overcome the learning curve of using the robot.
During Dr. Hu's fellowship, he was involved in the preop, intraop, and postoperative care of over 300 men undergoing robotic prostatectomy. In addition, Dr. Hu has proctored surgeons learning robotic assisted laparoscopic radical prostatectomy in California and Massachusetts. Dr. Hu has published several papers describing consistent anatomic landmarks for nerve-sparing and a technique to simplify the reconstructive stage of a robotic prostatectomy. Finally, Dr. Hu has performed over 550 robotic prostatectomies in Boston over the last 3 years.
Q. How do you track your outcomes in terms of continence and potency?
A. Patients commonly ask urologists what their risks of incontinence and impotence are following surgery. A study by Dr. Litwin showed that continence and potency rates reported by health care providers differ from that obtained from validated instruments such as the UCLA Prostate Cancer Index or the Expanded Prostate Cancer Index Composite. Furthermore, a recent papers by Dr. Spencer and Dr. Miller suggest that measuring continence and potency following treatment for prostate cancer with validated quality of life instruments are indicators of quality of care.
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