No surgery is free of the risk of complications or post-operative side effects. Though minimally invasive, a robotic-assisted laparoscopic prostatectomy is no different and presents a particular set of risks that could negatively impact a patient’s recovery and overall quality of life. The likelihood of complication is dependent upon many factors: a patient’s age, general health, and cancer stage, as well as the surgeon’s level of expertise can all influence the outcomes of a robotic-assisted prostatectomy. In general, clinical studies on robotic surgery for prostate cancer, such as the da Vinci® robotic prostatectomy, reveal outcomes that are equal to, and oftentimes, less than the known complications of traditional open prostatectomy procedures.
Surgical Complications of a Robotic Prostatectomy
Though low, there are a number of complications that could occur during or after a robotic-assisted prostatectomy, one of which is blood loss. As the prostate gland is nestled amongst a number of large blood vessels, intraoperative and post-operative blood loss is a known complication of a radical prostatectomy. As robotic prostatectomy surgery is a minimally invasive prostate cancer treatment, the risk of blood loss is substantially less when compared to traditional open procedure outcomes. According to a study conducted on patients of the Henry Ford Health System, 97 percent of robotic prostatectomy patients were not anemic at the time of discharge. Other complications include, but are not limited to, a deep venous thrombosis or blood clot originating in the legs or pelvic region, as well as a herniation of the bowl occurring at the port site, or area where the endoscope and robotic instrumentation enter the abdominal cavity.
Incontinence & Impotence after Prostatectomy Surgery
Due to the prostate’s location and anatomical components, incontinence and erectile dysfunction (impotence) are possible side effects of a radical robotic prostate cancer surgery. After the procedure, patients will experience some degree of incontinence during the recovery period. Why does this occur? Control of urinary function is made possible by two muscles, one of which resides within the prostate. After the prostate is removed and the urethra reconnected to the bladder, patients may experience incontinence until the remaining muscle responsible for urinary control strengthens over time.
Perhaps the greatest concern for men undergoing a radical prostatectomy, like the Da Vinci® robotic prostate surgery, is the risk of sexual dysfunction or the inability to achieve or hold an erection. During surgery, the nerve bundles responsible for erectile function may be removed if cancerous, stretched, or cut, however with early diagnosis, many patients may be candidates for a nerve-sparing prostatectomy. In this procedure, surgeons carefully preserve the neurovascular nerve bundles surrounding the prostate in hopes of maintaining sexual function. According to reports issued by the Vattikuti Institute of the Henry Ford Health System, 97 percent of patients who had undergone a nerve-sparing robotic prostatectomy at their facility experienced a return of sexual function. Of this group, 84 percent reported erections equal to those experienced before surgery and 13 percent reported erections strong enough for intercourse, but weaker than erections experienced prior to surgery. In terms of recovery, restoration of erectile function may take a period up to one to three years and is influenced by many outside factors including the patient’s age, emotional state, level of sexual activity, and the surgeon’s ability to successful spare neurovascular nerve bundles.