Robot-Assisted Prostate Surgery
Smaller trocars were used for the 8 mm Endo Wrist
instruments, then another was used as a drain. A second
12 mm trocar was used as an assistant port.
Notice how my abdomen is slightly inflated with CO2
gas through the attached clear tubing to allow an open
view of the prostate site and operating area with the
endoscope TV camera. The first trocar in was the ‘optical’
trocar so my surgeon could see what was happening with
the insertion of the remaining trocars and the required
FIGURE 12. The robot is aligned with the trocars.
that acts as a valve for empting the bladder. The urethra is
carefully severed from the other side of the prostate and
the gland is put into a small ‘zip lock bag’ to be removed.
The urethra is then stitched to the sphincter muscle to get
the patient’s plumbing back in order.
All of this takes from two and a half to three hours.
Just imagine the many hundreds of critical movements that
the surgeon has to perform! There are many instruments
FIGURE 13. Three different Endo Wrist end-effectors.
The Surgery Procedures
With the trocars in place, a catheter
hooked up, the abdomen inflated at 15
mm/Hg of pressure, and the endoscope
video and lighting in place, the da Vinci
robot is brought over and locked into
position over the patient. Each small step
is certainly more complex than the
following description, but I’m just giving
a quick timeline. The required Endo Wrist
instruments for the first part of the
surgery are slowly inserted through the
trocar and into the operation area. The
surgeon first severs the vas deferens and
the seminal vesicles, and removes them.
The bladder is lowered to reach the
prostate. The delicate procedure of
severing the prostate from the bladder is
performed as the surgeon must not
damage the bladder’s sphincter muscle
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