Preparation for prostatectomy with conventional or robot-assisted laparoscopy

How much time between the prostate biopsy and the prostatectomy?

The minimum delay between prostate biopsies that lead to a diagnosis of prostate cancer and the Da Vinci robot prostatectomy is about 6 weeks.

Prostatic biopsies can cause a local inflammatory reaction that is best left to reverse itself.

In fact a waiting period is necessary in order to conduct the examinations required for the work-up, in particular the examination with magnetic resonance imaging (MRI) that should not be done too soon after the biopsies for the same reason cited above: the inflammation of residual tissue may cause artifacts that can distort the interpretation of images, including the analysis of the integrity of the capsule.

This is also the time during which the patient thinks and chooses the treatment he wants from the various alternatives that have been proposed.
The patient consults his GP (general practitioner) who knows his personal dimension, physical, psychological, and also his family context the best. The patient can then be better advised taking into consideration all these different elements.

This period of 4 to 6 weeks between the diagnosis of prostate cancer and robot-assisted laparoscopic prostatectomy (RALP) poses no risk to the patient; this curable affliction will not evolve into an incurable form within this time period because the evolution of prostate cancer is usually relatively slow.

However, the maximum time between biopsies, staging and intervention should not exceed a few months. Any further delay and there is a risk that the information gathered on the development degree of the cancer deduced from analyzing the results of the biopsy and the MRI, from which the course of action was made could in fact be obsolete.

What kind of preparation is needed before robot-assisted prostatectomy?

The preparation for patients undergoing robot-assisted laparoscopic prostatectomy (RALP) surgery has minimal requirements compared to a normal pelvic surgery, especially when compared to the conventional open prostatectomy.

The operation is always preceded by a mandatory pre-anesthesia consultation, which must be done at least 48 hours before admission of the patient to the clinic.

In fact this delay period is most important for the anesthetist who conducts comprehensive assessments of the patient’s condition, including cardio-vascular and respiratory systems, and may need, due to the existence of other pathologies to contact various doctors in charge of the patient (cardiologist, diabetes specialist etc …) or ask for advice or for specialized examinations (carotid Doppler, electrocardiogram, etc …).

The pre-anesthesia consultation also allows the anesthetist to make necessary adjustments regarding treatments regularly followed by the patient.

This is particularly important before any surgery as medication that alters blood coagulation, including anticoagulants, aspirin and Anti-platelet accretion
Finally, this consultation allows the anesthesiologist and patient to agree on the mode of anesthesia, in this case for Da Vinci robot-assisted laparoscopic prostatectomy (RALP), a general anesthesia is obligatory, and to inform the patient of its advantages, disadvantages and eventual risks.

The necessary pre-operative examinations to be done externally are usually limited to a cyto-bacteriological examination of urine (CBEU). The final result may take a few days, since it is necessary to ensure the absence of a urinary infection before performing this surgery.

All the other tests are performed at the clinic at the time of admission the day before surgery, alongside a preoperative electrocardiogram and examination by a cardiologist at the institution. Chest x-ray will have already been performed with the work-up.

Before surgery, patients see a kinesitherapist specializing in urinary re-education, so that the quality of the sphincter and the perineal musculature can be evaluated and most importantly that the patient learns after 4 or 5 sessions the gymnastic perineal movements that he will need to practice after the operation in order to recover a good continence as quickly as possible.

We believe that it is easier to learn these movements correctly at this time instead of after the intervention, when the sensitivity of the pelvic region and perineum has changed.

A non residue diet is undergone to prepare the entire intestine during this pre-operative phase but even in cases with overweight patients, we do not impose slimming diets.

Obesity is never an asset in surgery because it makes the surgical movements more difficult and hemorrhagic. Obesity however, poses less of a problem to the surgeon in robot-assisted laparoscopy than in conventional open surgery.

The last precaution is to buy compression socks for the patient that they will wear during the surgery and in the weeks that follow.

This is a simple measure and without risk that helps prevent thromboembolism with its well-known risks of phlebitis of the lower limbs or pulmonary embolism.