This page features five short videos showing the important stages of a robot-assisted radical prostatectomy performed by Dr. Hu. We provide these videos so that our patients can see the precision enabled by this cutting-edge technology.
Part 1:
The prostate is located below the bladder, and in this step, Dr. Hu is dissecting out the anatomic plane between the prostate and bladder. The clear, white appearing tube is a bladder catheter that was placed at the start of surgery.
Part 2:
The seminal vesicles, which store most of the ejaculate, are being dissected out in this step. No cautery, or energy source is used to prevent injury to nerves that run in close proximity. Notice how the white clips are placed before dividing small blood vessels that feed the seminal vesicles. Next, Dr. Hu is dissecting the plane between the prostate and the rectum. The prostate is at the top of the screen, and its curved contour can be seen being pushed off of the rectum.
Part 3:
The neurovascular bundles are located posterolaterally on both sides of the prostate. This video segment demonstrates left neurovascular bundle nerve sparing. Dr. Hu used white clips prior to dividing the blood vessels that enter and exit the prostate, located at the left bottom corner of the screen. He is using the robotic scissors to delicately push and dissect off the cord of tissue that contains arterial and nerve tissue needed to preserve potency. Note again the absence of cautery/energy use which can damage the nerves. Despite the meticulous dissection, recovery of potency may take up to 18-24 months to plateau postoperatively. Although some men have regained full function within 2 months of surgery, younger age, excellent preoperative sexual function, and low tumor grade and volume (to allow aggressive nerve sparing) are key determinants to recovery of post-operative sexual function.
Part 4:
The prostate has been dissected away from surrounding structures except for the urethra, which is divided last. The prostate is then placed into a laparoscopic bag, before extending one of the small port sites to remove the specimen inside the bag. In addition, the surgical field is irrigated. Notice that clips have been used, and there are no signs of char/burns resulting from the use of energy/cautery.
Part 5:
The reconstructive phase involves sewing the bladder to the urethra around a foley catheter. A catheter usually stays in to drain the bladder for approximately 7 days while this area of reconnection heals. Furthermore, patients may experience blood in their urine for up to 6-8 weeks after catheter removal as these sutures dissolve and this surgical area continues to heal.
Comparing range of motion
This video clip demonstrates the greater range of motion of robotic instruments (with the white shaft) compared to traditional laparoscopic instruments (black shaft). Both instruments are coming in from the right side of the screen with the robotic scissors placed above the conventional laparoscopic scissors. While both scissors open and close and rotate in a 360-degree fashion by "twirling," the robotic instrument with the greater flexibility at the "wrist" allows dissecting in planes that the laparoscopic scissors does not allow. While Dr. Hu performs conventional laparoscopic surgery for kidney cancer and kidney donations, he feels that the increased range of motion leads to a greater range of working angles for dissection (during nerve-sparing and preservation of continence) as well as reconstruction (sewing the bladder to the urethra) during robotic-assisted laparoscopic radical prostatectomy.
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