Dr. Dean: The
Robotic Advantage
da Vinci Procedures
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Possible Risks and Complications
Prolonged procedure:
Operative times are usually the same or less than open prostatectomy for prostate cancer estimated between 2 and 4 hours with an average of 3 hours. There may be special circumstances where time may be longer but this can usually be anticipated. If procedures are prolonged other complications can occur such as rhabdomyolysis with or without renal failure. Renal failure has been reported with a prolonged procedure.
Conversion:
For sake of safety the robotic laparoscopic operation may have to be converted to a standard open operation (<1%). This may be related to how the operation is proceeding or in a rare instance that the robot may malfunction.
Blood loss:
Typically blood loss is 50 to 350 cc. Infrequently, there can be much more blood loss because of veins that bleed during nerve-sparing technique or from other parts of the operation. Transfusion is usually not necessary but blood will be on hand.
Pressure on nerves:
Because of positioning of your body on the operating room table there can be pressure points that are created because the body rests up against metal, an extremity (arm or leg) may be in an awkward position or the steep tilt of the table might produce shoulder nerve changes. These nerve pressures, if they occur, are typically transient but in a small percentage (<1%) can be long lasting.
Every precaution during the course of the procedure is taken to be sure that adequate padding is used to prevent nerve pressure.
Injury to other structures:
Although rare bowel injury may occur particularly in circumstances where previous surgery has led to adhesions in the abdominal cavity where the operation takes place. This is an infrequent occurrence (<1%). Injury to the rectum is also possible with past surgery to the prostate or because of scarring around the prostate Again rare ureteral injury(ureters are tubes that deliver urine to the bladder) can occur in cases where the prostate tissue extends into the bladder.
Hernia:
Tubes called ports are placed through small incisions so the instruments can pass through the abdominal wall to do the operation. Sometimes abdominal contents can poke through these abdominal incisions and cause pain. This is again an infrequent occurrence (<1%).
Anesthetic complications:
During your preop visit with the anesthesiology department the anesthesiologist will go over with you the possible problems that can occur related to anesthesiology.
Cardiopulmonary complications:
Pulmonary embolus or a blood clot from the pelvic or leg veins can go to the lungs and cause breathing problems or even sudden death. Cardiac arrest can occur from an irregular heart beat.
Impotence:
This is with or without assistance. Postoperatively you will be given a program to enhance your return to sexual function. One should expect return to function after two years. My desire is to have 82% of men potent at 12 months.
Incontinence:
At three months continence is 58% with full control in a year. My desire is to have 96% of men fully continent (no use of pads) at 12 months.
Cancer control:
Cancer control rates are actually better than open surgical procedures (10.7% in Smith's large series at Vanderbilt) compared with robotic technique which is 4-6%.
This website is provided for general information purposes only. Consult with your doctor about whether da Vinci ® Prostatectomy may be appropriate for your condidtion. If you have questions about the da Vinci ® Surgical System or the procedure, consult with your doctor.
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WILLIAM M. DEAN, MD
Specializing in Robotic Prostatectomy
Contact (Tacoma office):
314 Martin Luther King, Jr. Way, Suite 103
Tacoma, WA
98335-1700
Contact (Gig Harbor office):
4545 Point Fosdick Drive NW,
Suite 250
Gig Harbor, WA
98335-1700
Appointments
(Tacoma or Gig Harbor):
Tel: 253.272.4013
Fax: 253.627.5367
Office Hours
Tacoma: (Office is closed for lunch daily from 12-1)
Monday: 9-12 & 1-5
Tuesday: 9-12 & 1-5
Wednesday: Closed
Thursday: 9-12 & 1-5
Friday: 9-12 & 1-5
Gig Harbor:
Monday: Closed
Tuesday: Closed
Wednesday: Closed
Thursday: Closed
Friday: 1-5 on 1st & 3rd Friday Of Each Month
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