How is the prostate removed when doing robotic surgery?

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freinds
Regular Member


Date Joined Jun 2010
Total Posts : 76
   Posted 7/14/2010 12:30 PM (GMT -6)   
Heres an interesting question. I had robotic prostatectomy last week. My wife asked me how they get that walnut sized prostate gland out the pencil sized holes? eyes

Post Edited By Moderator (TC-LasVegas) : 7/14/2010 1:02:15 PM (GMT-6)


Steve n Dallas
Veteran Member


Date Joined Mar 2008
Total Posts : 4829
   Posted 7/14/2010 12:36 PM (GMT -6)   
Not sure what pencil sized hole you're referring too...but as I recall, it comes out of one the inch long incisions on the left. And since they don't have to worry about damaging it they yank the yeck out of it...
Age 55   - 5'11"   215lbs
Overall Heath Condition - Good
PSA - July 2007 & Jan 2008 -> 1.3
Biopsy - 03/04/08 -> Gleason 6 
06/25/08 - Da Vinci robotic laparoscopy
05/14/09  - 4th Quarter PSA -> less then .01
11/20/09 - 18 Month PSA -> less then .01
05/18/10 - 24 Month PSA -> less then .01
Surgeon - Keith A. Waguespack, M.D.


Tony Crispino
Veteran Member


Date Joined Dec 2006
Total Posts : 8128
   Posted 7/14/2010 12:56 PM (GMT -6)   
The prostate is inserted into a small bag while still in the abdominal cavity. Is is removed typically through the naval passage where the laparoscope is inserted, but it can be done at any of the incisions. While the incisions for the scope and robot arms are small, skin is elastic and can be stretched to allow for the specimen to be removed and analyzed. Typically the surgeon, will examine the prostate tumor palpability and compare it to the remaining facia tissue. If suspect the surgeon will continue dissecting the facia tissue specifically on the side where the tumor was palpable.

Complete DaVinci surgeries are available for viewing on YouTube.

Tony
Disease:
Advanced Prostate Cancer at age 44 (I am 47 now)
pT3b,N0,Mx (original PSA was 19.8) EPE, PM, SVI. Gleason 4+3=7

Treatments:
LARP ~ 2/17/2007 at the City of Hope near Los Angeles.
Adjuvant Radiation Therapy ~ IMRT Completed 8/07
Adjuvant Hormone Therapy ~ 28 months on Casodex and Lupron.

Status:
"I beat up this disease and took its lunch money! I am in remission."
I am currently not being treated, but I do have regular oncology visits.
I am the president of an UsTOO chapter in Las Vegas

Blog : www.caringbridge.org/visit/tonycrispino


Tony Crispino
Veteran Member


Date Joined Dec 2006
Total Posts : 8128
   Posted 7/14/2010 12:59 PM (GMT -6)   
friends I added a subject to you post...

Tony
Disease:
Advanced Prostate Cancer at age 44 (I am 47 now)
pT3b,N0,Mx (original PSA was 19.8) EPE, PM, SVI. Gleason 4+3=7

Treatments:
LARP ~ 2/17/2007 at the City of Hope near Los Angeles.
Adjuvant Radiation Therapy ~ IMRT Completed 8/07
Adjuvant Hormone Therapy ~ 28 months on Casodex and Lupron.

Status:
"I beat up this disease and took its lunch money! I am in remission."
I am currently not being treated, but I do have regular oncology visits.
I am the president of an UsTOO chapter in Las Vegas

Blog : www.caringbridge.org/visit/tonycrispino


Galileo
Veteran Member


Date Joined Nov 2008
Total Posts : 697
   Posted 7/14/2010 1:22 PM (GMT -6)   
Mine came out (in a bag, I presume) through a hole that was a lot bigger than a pencil. More like a slit half the size of my pinky. Right over my navel, where I developed a hernia later.

I watched BostonMed (great show) the other night and they were taking an appendix out laparoscopically. They put in in a bag and pulled it right out through a small hole. They called the whole thing the "worm", as it came out, as in "don't lose the worm". :)

There are lots of videos on the web of robotic prostatectomies, if you've got the stomach...so to speak.
Galileo

Dx Feb 2006, PSA 9 @age 43
RRP Apr 2006 - Gleason 3+4, T2c, NX MX, pos margins
PSA 5/06 <0.1, 8/06 0.2, 12/06 0.6, 1/07 0.7.
Salvage radiation (IMRT) total dose 70.2 Gy, Jan-Mar 2007@ age 44
PSA 6/07 0.1, 9/07 and thereafter <0.1
pcabefore50.blogspot.com


Fairwind
Veteran Member


Date Joined Jul 2010
Total Posts : 3744
   Posted 7/14/2010 3:14 PM (GMT -6)   
What would we do without plastic bags??
Age today: 68. Married, 6', 215 pounds, active, no health issues.
PSA at age 55: 3.5, DRE negative. Advice, "Keep an eye on it".
PSA at age 58: 4.5
PSA at age 61: 5.2
PSA at age 64: 7.5, DRE "Abnormal"
PSA at age 65: 8.5, DRE " normal", biopsy, 12 core, negative...
PSA at age 66 9.0 DRE "normal", BPH, Finesteride. (Proscar)
PSA at age 67 4.5 DRE "normal" second biopsy, negative.
PSA at age 67.5 5.6, DRE "normal" U-doc worried..
PSA at age 68, 7.0, third biopsy positive for cancer in 4 cores, 3 cores Gleason 6, one core Gleason 9. Finesteride discontinued, still no urinary symptoms, never had any..From age 55 to 65 I had no health insurance.

I have a date with the robo surgeon on Sept 3 but I'm keeping my options open. A "top" radiation oncologist here in Denver, equipped with the latest IMRT/IGRT/RapidArc machine says he can do better by me..


Im_Patient
Veteran Member


Date Joined Aug 2009
Total Posts : 665
   Posted 7/14/2010 8:16 PM (GMT -6)   
My prostate was about 60g, larger than most, and I have a much longer slit on the lower right side that I believe the surgeon mentioned was used to bring it out. I am betting the cut with the slit (if there is one) is proportional to the size so as to manage to get it out effectively.
Gleason, 3+4; PSA, 7.9
Robotic Prostatectomy, March 2008 (Age 48 then), nerves both sides spared, post surgery analysis confirmed 3+4 Gleason,
pT2c, prostate 60.2g, margins: negative; perineural invasion: present; lymphatic invasion: present; 3 lymph nodes removed, clear; seminal vesicle invasion: absent; Gleason 4 comprises 5-10% of carcinoma
PSA consistently <0.1 since surgery until Oct 09: 0.1; retested Oct 09, <0.1,
Jan 10, 0.2
retest Feb 1 confirmed 0.2
CT scan, bone scan Feb 10 both clear
PSA after, 2010: March, 0.17; April, 0.17; May, 0.24; June, 0.31; July, 0.29
Starting salvage IGRT on August 4, plan 72Gy


142
Forum Moderator


Date Joined Jan 2010
Total Posts : 6949
   Posted 7/14/2010 8:37 PM (GMT -6)   
My Dr said he took it out through the camera port (above the navel, largest cut).

Fairwind
Veteran Member


Date Joined Jul 2010
Total Posts : 3744
   Posted 7/14/2010 8:55 PM (GMT -6)   
I wish I could just sh!t it out....I mean, it's just a quarter inch away....!

I don't know who to blame for this, God or Darwin...
Age today: 68. Married, 6', 215 pounds, active, no health issues.
PSA at age 55: 3.5, DRE negative. Advice, "Keep an eye on it".
PSA at age 58: 4.5
PSA at age 61: 5.2
PSA at age 64: 7.5, DRE "Abnormal"
PSA at age 65: 8.5, DRE " normal", biopsy, 12 core, negative...
PSA at age 66 9.0 DRE "normal", BPH, Finesteride. (Proscar)
PSA at age 67 4.5 DRE "normal" second biopsy, negative.
PSA at age 67.5 5.6, DRE "normal" U-doc worried..
PSA at age 68, 7.0, third biopsy positive for cancer in 4 cores, 3 cores Gleason 6, one core Gleason 9. Finesteride discontinued, still no urinary symptoms, never had any..From age 55 to 65 I had no health insurance.

I have a date with the robo surgeon on Sept 3 but I'm keeping my options open. A "top" radiation oncologist here in Denver, equipped with the latest IMRT/IGRT/RapidArc machine says he can do better by me..


Sleepless09
Veteran Member


Date Joined Jul 2009
Total Posts : 1267
   Posted 7/14/2010 9:07 PM (GMT -6)   
Friends, you ask how they get it out. I don't know for sure, but I hope verrrrrrry carefully.

Sheldon AKA Sleepless
Age 67 in Apil '09 at news of 4 of 12 cores positive T2B and Gleason 3 + 3 and 5% to 25% PSA 1.5
Re-read of slides in June said Gleason 3 + 4 same four cores 5% to 15%
June 29 daVinci prostatectomy, Dr. Eric Estey, at Royal Alexandra Hospital Edmonton one night stay
From "knock out" to wake up in recovery less than two hours.  Actual surgery 70 minutes
Flew home to Winnipeg on July 3 after 5 nights in Ramada Inn  ---  perfect recovery spot!
Catheter out July 9
Final pathology is 3 + 4 Gleason 7, clear margins, clear nodes, T2C, sugeron says report is "excellent"
 
Oct 1st 09 -- dry at night, during day some stress issues.
Oct 31st padless 24/7 
 
First post op PSA Sept 09  less than 0.02
PSA on Oct 23 test again less than 0.02
PSA on Jan 8 less than 0.02
PSA on April 9 less than 0.02 
 
  


Fairwind
Veteran Member


Date Joined Jul 2010
Total Posts : 3744
   Posted 7/14/2010 9:32 PM (GMT -6)   
Apparently the Canadian health-care system is not as bad as our politicians have led us to believe..:)
Age today: 68. Married, 6', 215 pounds, active, no health issues.
PSA at age 55: 3.5, DRE negative. Advice, "Keep an eye on it".
PSA at age 58: 4.5
PSA at age 61: 5.2
PSA at age 64: 7.5, DRE "Abnormal"
PSA at age 65: 8.5, DRE " normal", biopsy, 12 core, negative...
PSA at age 66 9.0 DRE "normal", BPH, Finesteride. (Proscar)
PSA at age 67 4.5 DRE "normal" second biopsy, negative.
PSA at age 67.5 5.6, DRE "normal" U-doc worried..
PSA at age 68, 7.0, third biopsy positive for cancer in 4 cores, 3 cores Gleason 6, one core Gleason 9. Finesteride discontinued, still no urinary symptoms, never had any..From age 55 to 65 I had no health insurance.

I have a date with the robo surgeon on Sept 3 but I'm keeping my options open. A "top" radiation oncologist here in Denver, equipped with the latest IMRT/IGRT/RapidArc machine says he can do better by me..


Sleepless09
Veteran Member


Date Joined Jul 2009
Total Posts : 1267
   Posted 7/14/2010 11:02 PM (GMT -6)   
Fairwind --- you made me smile. Just as I did when the hospital sent me a bill for $25 for one night in a semi-private room, which was the total cost for hospital, doctors, drugs, a package of goodies to take home --- you name it. Ahhhhh!

Love those smiles!

Keep us posted on your upcoming dance with da Vinci. Or, whatever it is you decide to do.

Sheldon AKA Sleepless
Age 67 in Apil '09 at news of 4 of 12 cores positive T2B and Gleason 3 + 3 and 5% to 25% PSA 1.5
Re-read of slides in June said Gleason 3 + 4 same four cores 5% to 15%
June 29 daVinci prostatectomy, Dr. Eric Estey, at Royal Alexandra Hospital Edmonton one night stay
From "knock out" to wake up in recovery less than two hours.  Actual surgery 70 minutes
Flew home to Winnipeg on July 3 after 5 nights in Ramada Inn  ---  perfect recovery spot!
Catheter out July 9
Final pathology is 3 + 4 Gleason 7, clear margins, clear nodes, T2C, sugeron says report is "excellent"
 
Oct 1st 09 -- dry at night, during day some stress issues.
Oct 31st padless 24/7 
 
First post op PSA Sept 09  less than 0.02
PSA on Oct 23 test again less than 0.02
PSA on Jan 8 less than 0.02
PSA on April 9 less than 0.02 
 
  


Sephie
Veteran Member


Date Joined Jun 2008
Total Posts : 1804
   Posted 7/15/2010 5:11 AM (GMT -6)   
During robotic surgery, 5 incisions are made with the largest being right above the navel. The prostate is pulled through that incision in a little plastic bag with a string on it. This was explained to us by our surgeon. When my husband asked how something the size of a walnut can be pulled out of a hole that small, the surgeon looked at us and with a straight face said "come on, John, think childbirth."
Husband diagnosed in 2/2008 at age 57 with stage T1c. Robotic surgery performed 3/2008. Stage upgraded to T3a (solitary focus of extraprostatic extension). Perineural tumor infiltration present. Apex margin, bladder neck and SVs negative. Final Gleason 3+4. PSA: 0.0 til July 2009. August 2009 - 0.1, September 0.3, October back to 0.0, December 0.0, March 2010 0.0. Next PSA in 6 months. Thank you God!


Gleason7
Regular Member


Date Joined Feb 2010
Total Posts : 111
   Posted 7/15/2010 7:12 AM (GMT -6)   
At 106 grams mine came out much like the others or plastic bag and the incision typically used from what I've read is at the navel or the largest of the five access points. Not sure why a plastic bag is used as from what I've read prostate cancer, unlike others does not transfer as other types can. Not to worry as plastic is produced from petroleum which is a no no with the Obama administration and will eventually be banned which will require the surgeon to use a "brown bag"! devil

74 - Henry Ford Vatikutti DiVinci 2/10/10 - 106 grams - 3+4 =7 - Three month PSA .o6 - Five month PSA undetectable - zero pads after Two months - sneeze / lifting leaks yes. ED back to where we were with 50 MG Viagra for party time....some leaking at party time is a major turnoff. No regrets! I owe Dr. Peabody a ton!

Kolin6
New Member


Date Joined Mar 2010
Total Posts : 16
   Posted 7/15/2010 8:24 PM (GMT -6)   
I had a prostatectomy eight years ago.
The doctor made a cut between the anus and the testicles.
When I had the stitches (Staples) removed, I asked the nurse how many.
She said there was fourteen.  Nothing was ever mentioned to me about
doing it any other way.   On this board is the first time I have ever
heard of any other way.
Maybe this is why I am having such a bad time with ED. None of the chemicals
work, that's why I am now trying a pump.

Tony Crispino
Veteran Member


Date Joined Dec 2006
Total Posts : 8128
   Posted 7/15/2010 8:54 PM (GMT -6)   
Hi Kolin,
You had the open Perineal procedure. This procedure has been abandoned for the most part. It is still done only in cases where the patient had previous procedure such as a hernia operation. The typical procedure that is done with open cuts is retropubic which is a cut from navel to the pubic area, or by Laparoscope which is a series of holes for the instruments.. In the case this poster is was a robotic thus his question is if they make small incisions, how do you get the prostate out? In most cases it is by using a bag to contain the tissue, and then pulling it out the navel incision.

In open procedures, retropubic is done to provide better access to nerves in a nerve sparing procedure. This in hopes of preventing issues like the one you are experiencing with ED.

Tony
Disease:
Advanced Prostate Cancer at age 44 (I am 48 now)
pT3b,N0,Mx (original PSA was 19.8) EPE, PM, SVI. Gleason 4+3=7

Treatments:
RALP ~ 2/17/2007 at the City of Hope near Los Angeles.
Adjuvant Radiation Therapy ~ IMRT Completed 8/07
Adjuvant Hormone Therapy ~ 28 months on Casodex and Lupron.

Status:
"I beat up this disease and took its lunch money! I am in remission."
I am currently not being treated, but I do have regular oncology visits.
I am the president of an UsTOO chapter in Las Vegas

Blog : www.caringbridge.org/visit/tonycrispino


Kolin6
New Member


Date Joined Mar 2010
Total Posts : 16
   Posted 7/15/2010 9:29 PM (GMT -6)   
Thanks Tony for the reply, I knew none of this.
Now......do you have any tips for the ED?
Kolin6

Im_Patient
Veteran Member


Date Joined Aug 2009
Total Posts : 665
   Posted 7/15/2010 10:44 PM (GMT -6)   
Kolin, many of us here have used penile injections (caverject, bimix, or trimix) to very successfully get erections similar to before the surgery. You can get your urologist to prescribe them.
Jeff
Gleason, 3+4; PSA, 7.9
Robotic Prostatectomy, March 2008 (Age 48 then), nerves both sides spared, post surgery analysis confirmed 3+4 Gleason,
pT2c, prostate 60.2g, margins: negative; perineural invasion: present; lymphatic invasion: present; 3 lymph nodes removed, clear; seminal vesicle invasion: absent; Gleason 4 comprises 5-10% of carcinoma
PSA consistently <0.1 since surgery until Oct 09: 0.1; retested Oct 09, <0.1,
Jan 10, 0.2
retest Feb 1 confirmed 0.2
CT scan, bone scan Feb 10 both clear
PSA after, 2010: March, 0.17; April, 0.17; May, 0.24; June, 0.31; July, 0.29
Starting salvage IGRT on August 4, plan 72Gy

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