I want to share my recent prostatectomy surgery. We all hear about having nerve sparing surgery but their are now even more advancements in the surgery.
I was dry with no leaking immediately after the catheter was removed. The latest DaVinci Robotic technique is a single port entry. Only one very small vertical incision above your belly button not your typical three or four incisions. In a certain technique which not all Surgeon’s are trained in, the Surgeon is able to spare what’s called the puboprostatic ligament during robotic prostatectomy. In essence my Surgeon said this technique keeps the continence mechanism intact and it also helps maintain urethral length. A longer urethra allows for more control in the release of urine reducing the likelihood of incontinence and also the Puboprostatic ligament provides support to the urethra in keeping it in its position. He further does Retzius sparing of the tissue between the bladder and the prostate which further helps with continence. Another benefit of sparing the Puboprostatic ligament is the less likelihood the patient will see any reduction in their penile size that many patients report by either perception of it or a slight amount as its drawn in. He stated that this keeps the bladder anatomy more intact and in it’s natural place.
He explained that during Surgery I am certainly not upside down but he will operate through the Davinci robotic system as if I were upside down during the surgery. He said many surgeons are not familiar in the use of this approach and this is how he is able to spare the ligament. He said it was developed by a European Surgeon.
He also while I was under anesthesia sent my initial tissues immediately to Pathology to get an immediate staining for positive or negative margins. He was not expecting anything as the PET scan had indicated everything was in the capsule and from his experience did not see anything suspicious in the outlying tissue, however although the lymph nodes came back negative, there was positive margin, having just left the capsule. He then had to go back in and spent additional two hours trying to cut what he could to eliminate the positive margin. At that point I needed then to wait two weeks until I saw him and he said the final pathology report showed negative margins.
I know when people are considering Surgery, and questioning surgeons in consultation in addition to inquiring about nerve sparing, ask about single port, Puboprostatic ligament sparing and Retzius sparing and where they may be currently done.