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Robotic Prostatectomy and Ventral Hernia Repair

I am writing this narrative to detail my experience as a result of undergoing robotic assisted prostate surgery. I will be forwarding this document to my physician, Dr. Domenico Savatta, and he may use this information as he chooses. My recovery from surgery may not be typical, but others contemplating this type of surgery may be interested in my experience.

I am a 60 year old Caucasian male who was diagnosed with Prostate cancer in October 2005. The cancer was discovered very early, and the cancer growth was minimal. My Gleason score was 6. My urologist recommended two potential courses of action; radical prostate surgery or radiation therapy.

My urologist shared with me that robotic assisted surgery had developed to a degree that offered all of the benefits of a traditional radical Prostatectomy, but with an accelerated recovery time and a procedure that was a fairly “bloodless” one. He, himself, did not perform this type of surgery. My urologist offered me two names of surgeons in the Northern New Jersey area who were experienced in this type of surgery. I contacted both practices.

During the initial contact I made with one of the recommended surgeons I was questioned about my height and weight. I am 5’ll” and weigh 245 lbs. The office staff indicated that a diet may be recommended by the doctor prior to surgery. The indication was that patients do better if they are thinner.

I contacted the other recommended surgeon and scheduled an appointment. I saw Dr.
Domenico Savatta of Associates in Urology in mid-November and we discussed robotic assisted surgery. The Doctor was very informative and thoroughly discussed all options that were available to me. I was concerned about the potential duration of anesthesia since I had a negative experience with anesthesia in a prior surgery. I expressed interest in cryosurgery because I believed it would be less invasive and would require less time under anesthesia. Dr. Savatta indicated that he could arrange that I speak to a doctor experienced in the technique of cryosurgery.

Dr. Savatta performed an examination of my abdomen and we discussed the ramifications of my obesity and some scar tissue resulting from abdominal surgery which occurred approximately 20 years ago. Doctor indicated that if surgery was to be performed, he would call in, as a consult, a general surgeon to assist him in the surgery. Dr. Savatta gave me the name of his choice of assisting surgeon, Adam Kopelan, MD. Dr Kopelan is an experienced surgeon who utilizes robotic assisted surgery in his practice.

I consulted with Jeffery Katz, MD about cryosurgery. His recommendation, based on my age and the data of survival rates for cryosurgery, was that the prostate be removed. Dr. Katz called the removal process as the “gold standard” of addressing prostate cancer. I considered radiation therapy and decided against it. I felt that the regimen of this therapy was too disruptive to my life and the results of this technique did not approach that of removal of the prostate.

I made an appointment with Dr. Kopelan and we discussed his role in my anticipated surgery. Dr. Kopelan examined my abdomen and paid particular attention to the surgical site of my Diverticulosis surgery that I had 20 years ago. Doctor explained that his role was to “clean up” any adhesions that might be present from the old surgery. Dr. Kopelan detected a hernia in the upper right quadrant of my abdomen during his examination. He felt that the hernia could be repaired on the day of my prostate surgery. A CAT scan of the abdomen was recommended and obtained prior to surgery.

I scheduled surgery with Dr. Savatta for December 19, 2005.

Before surgery I instructed Dr. Savatta not to employ any nerve sparing techniques in order to mitigate sexual dysfunction. I told Dr. Savatta that I would rather that the operation went as quickly as possible to minimize the amount of time I was under anesthesia. I felt it important that the time possibly spent in attempting to save nerves would be better spent by shortening the overall procedure. Sexual potency, after attempting to save nerves would be better spent by shortening the overall procedure. Sexual potency, after the surgery, was not an issue for me.

I entered Newark Beth Israel Hospital early the morning of December 19. Surgery was scheduled for 9:00am. Doctors Savatta and Kopelan were present. Surgery lasted less than four hours. I went to the recovery room. I was released from the recovery room and was transferred to my room by 1:45pm that afternoon. I was able to move from the recovery room stretcher to my hospital bed with little pain or discomfort. I was connected to an IV and began receiving a series of antibiotic medicines. I was also attached to a self-medicating Morphine drip. Dr. Savatta stopped by to inquire of my condition and pain level. I told him that I felt good and I was in very little pain.

My wife and children visited at 3:00pm.

I was released from Beth Israel the following day at 11:00am. I was given a prescription for pain medication before leaving the hospital. I was given a leg-bag catheter and a large bed-side catheter bag. I was cautioned not to lift any weight over twenty pounds. I was so happy to be leaving the hospital, that I declined the traditional wheelchair and walked out of the hospital to my car in the parking garage. I began my recuperation at home.

During my recuperation I had a catheter that was placed to allow time for my bladder sutures to heal. I was scheduled to return to Dr. Savatta’s office eight days after surgery, to determine if the bladder/urethra incision had healed. It had not. Because of the way the week fell, a weekend and a holiday postponed the removal process. The catheter was to remain in place for another six days. On the following office visit the catheter was removed. It was fourteen days after my surgery. Once the catheter was removed I had some leakage of urine. It did not stop me, however, from going to dinner with my wife to celebrate the removal of the catheter.

The evening of the first day of the catheter removal I dribbled frequently. I wore a disposable undergarment to bed that night, since I was unsure what level of continence I would have while I slept. I woke up the following morning and the “diaper” front was slightly damp.

I put on a fresh diaper and began my day. While sitting, I had no leakage. When I would stand and walk, some dribbling would occur. I tried to empty my bladder frequently throughout the day since I found that an empty bladder decreased the amount of dribbling which would occur when I walked. I drank at least 64oz. of water each day to stave off a urinary tract infection. I wore a diaper the second night after the catheter removal and found, on the following morning, a substantially drier diaper than the previous day. I never wore a diaper to bed at night after the second day.

I continued to drink large quantities of water each day. I also experienced a substantial decrease in dribbling over the course of one week after the catheter was removed. Within a month from the date of surgery I would consider myself “dry”. I do dribble very slightly on an infrequent basis when my bladder is somewhat full during the day. But the frequency and amount of urine leakage is insignificant.

At night, I can maintain urinary control of a full bladder. I can get up, walk to the bathroom during the night to void without dribbling. I have not slept the night without waking to urinate, but I do consume a 22oz. mug often in the evening. I’m certain if I avoided liquids in the evening, I would be able to sleep the entire night without waking to void.

I have experienced no pain during the recuperation period. I never felt it necessary to fill the prescription I was given at the time of my hospital discharge. And I was very surprised how painless this surgery was as compared to the abdominal surgery I had long ago. The only pain I felt would be best described as discomfort. The discomfort level was that, on occasion, I would feel a “pulling” sensation in my abdomen.

I certainly cannot consider that to be pain!

I am unsure which of the surgeries caused this pulling sensation; the hernia repair or the prostate removal. In either case, the discomfort level was minimal and isolated. I did wear a belly band around my abdomen during the first two weeks of my recuperation. After that time, I no longer wore the band unless I was planning to do some physical job around the house.

I feel that I made a wise decision when I chose robotic assisted surgery. My feeling of well being during the entire recuperation period was excellent and I feel myself to be almost completely recovered.

I hope that this information will be of some use to individuals contemplating this type of surgery. Robotic assisted surgery certainly worked for me.

Stephen J Donahue January 25, 2006