If, like me, you have never had a serious surgical operation in your adult life, the process is somewhat disquieting, not to say alarming. There is a team of people of all ages and experiences who swarm around you. In an age of litigation, there is much risk understanding paperwork, checks on who you are, why you’re there and a final are you sure? moment.

The phrase robotic surgery can conjure up visions of Marvin the Paranoid Android in a gown and mask. The reality is of course that this is a robot-assisted procedure. Strictly, there is no robot at all, just a servo-assisted mechanical system that is, frankly, more precise than a human surgeon, i.e. it’s tools can be placed precisely and repeatedly in the same position and with the same applied force. Combined with the laporoscopic (“keyhole”) technique, the whole system can be operated (relatively) remotely by surgeons sitting at a workstation away from the operating table, viewing by high definition cameras inside the abdomen.

The procedure involves 6 smallish incisions around the waistline to provide access for the robotic arms and instruments, a camera port and an egress point for the excised tissue. The procedure is intrinsically more sterile than open surgery, and inflating the abdomen with gas (CO2) provides a little more room inside the operating cavity.

So far so good.

In my case, anaesthesia involved a spinal block and a general anaesthetic.

The operation proved much more challenging than predicted. Here are some highlights from the operation notes.

Findings:
Challenging prostatectomy
Abnormal BN Anatomy (Bladder neck)
Big prostate, vascular pedicles
Short urethra anatomically

Operation Note:
….
Sigmoid adhesions released
Dennonvilliers opened and rectum pushed posteriorly
Bladder dropped anteriorly and mobilised
Periprostatic fat resected and sent for histology
Bilateral endopelvic fascia opened
Bladder neck dissection: Initially started by *** then *** took over. Very challenging BN dissection, abnormal anatomy. Prostatic nodules?
Pedicles clipped
Left interfascial NVB spared (neurovascular bundle)
DVC cutted
Urethra divided
Prostate removed
…..

There was more, all including a leaking bladder neck repair and a couple of goes at getting the catheter in the right place.
So it was all a lot more complicated than anticipated, including a ‘I can’t do this , you have a go’ moment. . When a surgeon says ‘challenging’ that’s code for ‘ completely fucked up’.

So coming out of this, recovery was going to be a much longer and more limited process, and there was a good chance that there was still cancer in the surrounding tissue. The histology results a few weeks later confirmed this. Could the outcome have been different if the operation had happened earlier? Was watchful waiting the right move and was there enough watching or too much waiting? Why didn’t any of the scans identify the ‘abnormal anatomy?’ or was it missed? These can only be rhetorical questions now, but i hope the specialists learned something that will prevent this happening again to others.

The operation over, I began the journey that continues today and inspired the Prostate Annals.

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