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      ROBOTIC SURGERY

          A robotic surgical system provides surgeons with an alternative to both traditional open surgery and conventional laparoscopy, putting a surgeon's hands at the controls of a state-of-the-art robotic platform. It enables surgeons to perform even the most complex and delicate procedures through very small incisions with unmatched precision.

          For the patient, benefits may include:

            • Significantly less pain
            • Less blood loss
            • Less scarring
            • Shorter recovery time
            • A faster return to normal daily activities
            • In many cases, better clinical outcomes


          Learn More About Robotic Surgery







          ROBOT-ASSISTED LAPAROSCOPIC RADICAL PROSTATECTOMY (da Vinci® Prostatectomy)

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          About the Procedure

          Facing any kind of urologic surgery creates a great deal of anxiety for most men. Among your concerns is: "Will my body function normally following surgery?" Traditional open urologic surgery—in which large incisions are made to access the pelvic organs—has been the standard approach when surgery is warranted. Yet common drawbacks of this procedure include significant post-surgical pain, a lengthy recovery and an unpredictable, potentially long-term impact on continence and sexual function.
          Robotic Surgery, a minimally-invasive approach that utilizes the latest in surgical and robotics technologies, is ideal for delicate urologic surgery. This includes prostatectomy, in which the target site is not only tightly confined but also surrounded by nerves affecting urinary control and sexual function.
          The procedure is performed through 6 dime-sized incisions in the abdomen, and one of the incision is widened slightly to remove the prostate itself. The procedure usually takes about 3 to 5 hours and you should expect to spend 1 night in the hospital.

          Learn More About this Procedure


          Preparing for the Procedure:

          Take only clear liquids on the day prior to the procedure. Acceptable liquids include tea or coffee (no milk or cream), water, apple juice, Gatorade or other sports drinks, popsicles, italian ice or chicken broth.

          Drink five ounces of citrate of magnesium at 4:00 pm the day before the procedure. If this does not produce a bowel movement by 7:00 pm take an additional 2 ounces of citrate of magnesium. This is available over the counter in the laxative section of your pharmacy. Remember to drink plenty of clear liquids to stay hydrated while preparing for your procedure.

          Do not eat or drink anything after midnight the night before the procedure. You should take your usual medications as you normally would the morning of your procedure with a small sip of water only (avoid juice, milk, coffee, etc.).

          Starting 5 to 10 days prior to your procedure (ask your doctor for a specific time), it is important to stop taking medications that might increase your risk of bleeding. For a list of blood-thinning medications that should be avoided, click here or ask you doctor.

          Additionally, your doctor may have prescribed for you an enema which should be taken rectally 2 hours before coming in to the hospital on the day of your surgery. Check the packaging of the enema for specific instructions.

          After the Procedure:

          General:

          • You will be discharged with a catheter in your bladder. This is typically left in place for 1 to 2 weeks.
          • The catheter should only be removed by your Urologist
          • Drink 6 to 8 glasses (1500cc) of fluid daily until the catheter is removed
          • If blood appears in your urine (red fluid in the tubing of the catheter), increase your fluid intake and decrease your activity level until it clears
          • Unless instructed otherwise, avoid taking aspirin, anti-inflammatory medications (ibuprofen, etc.), or blood thinners until you are seen in the office
          • Do not use any rectal suppositories or enemas
          • Remove the dressings from all incisions on the second day after surgery and leave the incisions open to air
          • Contact the office immediately you experience any of the following:
            • Swelling of one or both legs
            • Chest pain
            • Shortness of breath
            • Fevers higher than 100.5° F
            • Catheter stops draining

          Activities:

          • You can and should walk around freely (rest in bed only when tired)
          • You may climb up and down stairs slowly
          • You may shower with the catheter, but do not soak in a tub or take baths
          • You should not drive until your catheter has been removed (it is ok to ride in a car) or if you are taking narcotic pain medication
          • Avoid strenuous activity, exercise, and heavy lifting (more than 20 lbs.) for 4 weeks after your surgery
          • No bicycle or horseback riding for 8 weeks after surgery

          Diet:

          • You may eat your usual diet when at home
          • In addition to the pain medication, you should take the prescribed stool softener to prevent constipation
          • If you do not have a bowel movement within 3 days of your surgery, begin taking over-the-counter milk of magnesia twice daily until your fist bowel movement
          • Limiting the narcotic pain medication will help decrease constipation

          Catheter care:

          • While at home, keep the catheter connected to the large drainage bag
          • It is OK to use the smaller drainage bag if you plan on going out of the house
          • It is normal for your catheter to have pink to reddish urine, especially with increased activity or bowel movements
          • Decreasing your activity and increasing fluids will usually make the urine clear
          • You may notice pink discharge at the tip of the penis—this is normal
          • Applying over-the-counter antibacterial ointment (e.g. Neosporin or Bacitracin) 2 to 4 times daily to the tip of the penis will help decrease irritation

          Common Problems:

          • Leakage around the catheter:
          • This is a common problem often related to bladder spasms (leakage may be accompanied by the urge to urinate or lower abdominal pain/cramping). If urine is still draining through the catheter tubing, as well as around it, use absorbent pads to stay dry. Increase you fluid intake and decrease your activity—the spams should pass
          • If the spasms are severe, call the office and a medication to help control them can be prescribed.

          Scrotal/Penile swelling:

          • Swelling of the penis and/or scrotum is not unusual and should improve with time. It may help to elevate the scrotum with a soft towel behind the scrotum while seated or lying down

          Incision opening:

          • If an the skin of an incision should open, you may clean it with hydrogen peroxide and apply a clean gauze to cover it twice daily.

          Bruising around the incision:

          • This is normal and will get better with time.

          Constipation/bloating:

          • This is common after surgery. Walking, increasing fluids, and decreasing the use of narcotic pain medications will usually help improve these symptoms (see Diet instructions above)








          ROBOT-ASSISTED LAPAROSCOPIC NEPHRECTOMY


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          About the Procedure:

          The kidneys are paired organs behind the abdomen that filter blood and create urine. Robot-assisted laparoscopic nephrectomy is the minimally invasive removal of a kidney, usually as a result of a tumor or because the kidney no longer functions. This helps avoid a large incision, a long hospital stay, long recovery time, and offers more cosmetically appealing results. Additionally, the use of the robotic surgery platform allows your doctor to remove the tumor more quickly, exposing you and your kidneys to less stress and potential damage. The procedure is done through 3 to 4 dime-sized incisions in the abdomen, and a separate 6 to 7 centimeter incision is made to remove the kidney itself. The procedure usually takes about 3 to 4 hours and you should expect to spend at least 1 night in the hospital.

          Learn More about the Procedure


          Preparing for the Procedure:

          Take only clear liquids on the day prior to the procedure. Acceptable liquids include tea or coffee (no milk or cream), water, apple juice, Gatorade or other sports drinks, popsicles, italian ice, or chicken broth.

          Drink five ounces of citrate of magnesium at 4:00 pm the day before the procedure. If this does not produce a bowel movement by 7:00 pm take an additional 2 ounces of citrate of magnesium. This is available over the counter in the laxative section of your pharmacy. Remember to drink plenty of clear liquids to stay hydrated while preparing for your procedure.

          Do not eat or drink anything after midnight the night before the procedure. You should take your usual medications as you normally would the morning of your procedure with a small sip of water only (avoid juice, milk, coffee, etc.).

          Starting 5 to 10 days prior to your procedure (ask your doctor for a specific time), it is important to stop taking medications that might increase your risk of bleeding. For a list of blood-thinning medications that should be avoided, click here or ask you doctor.


          After the Procedure:

          There will be dressings on the incisions that can be removed on the second day after the procedure. After that, it is OK to shower (let soap and water run over the incision, then pat dry), but baths and soaking in a tub should be avoided for 2 weeks after the procedure. The incisions should be kept clean and dry to allow them to heal, so it is important to shower once a day. The incisions generally heal in five to seven days, but avoid any strenuous activity and exercise or heavy lifting for 4 to 6 weeks after the procedure. Your doctor will remove the surgical staples in your incisions at your first office visit following your discharge from the hospital. This is not painful and only takes a few minutes.

          It is usually OK to resume your blood-thinning medication the day after your procedure, but check with your doctor to be sure. Take all the medications prescribed by your doctor (including any antibiotics and pain medications), and schedule an appointment to follow up with him within the first 2 weeks after the procedure (ask your doctor if you are unsure when to follow up).

          Make arrangements for someone to drive you home on the day of your discharge from the hospital.


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          ROBOT-ASSISTED LAPAROSCOPIC PARTIAL NEPHRECTOMY


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          About the Procedure:

          Occasionally, kidney cancer can be removed without having to remove the entire kidney. This can be done in a minimally invasive fashion during a robot-assisted laparoscopic partial nephrectomy, which helps avoid a large incision, a long hospital stay, long recovery time, and offers more cosmetically appealing results. Additionally, the use of the robotic surgery platform allows your doctor to remove the tumor more quickly, exposing you and your kidneys to less stress and potential damage. This is accomplished through 3 to 5 dime-sized incisions in the abdomen. The 6 to 7 centimeter incision used during a laparoscopic nephrectomy does not usually need to be made, since there is no need to remove the entire kidney. The procedure usually takes about 3 to 4 hours and you should expect to spend at least 1 night in the hospital.

          Learn More about the Procedure

          Preparing for the Procedure:

          Take only clear liquids on the day prior to the procedure. Acceptable liquids include tea or coffee (no milk or cream), water, apple juice, Gatorade or other sports drinks, popsicles, italian ice, or chicken broth.

          Drink five ounces of citrate of magnesium at 4:00 pm the day before the procedure. If this does not produce a bowel movement by 7:00 pm take an additional 2 ounces of citrate of magnesium. This is available over the counter in the laxative section of your pharmacy. Remember to drink plenty of clear liquids to stay hydrated while preparing for your procedure.

          Do not eat or drink anything after midnight the night before the procedure. You should take your usual medications as you normally would the morning of your procedure with a small sip of water only (avoid juice, milk, coffee, etc.).

          Starting 5 to 10 days prior to your procedure (ask your doctor for a specific time), it is important to stop taking medications that might increase your risk of bleeding. For a list of blood-thinning medications that should be avoided, click here or ask you doctor.


          After the Procedure:

          There will be dressings on the incisions that can be removed on the second day after the procedure. After that, it is OK to shower (let soap and water run over the incision, then pat dry), but baths and soaking in a tub should be avoided for 2 weeks after the procedure. The incisions should be kept clean and dry to allow them to heal, so it is important to shower once a day. The incisions generally heal in five to seven days, but avoid any strenuous activity and exercise or heavy lifting for 4 to 6 weeks after the procedure. Your doctor will remove the surgical staples in your incisions at your first office visit following your discharge from the hospital. This is not painful and only takes a few minutes.

          It is usually OK to resume your blood-thinning medications the day after your procedure, but check with your doctor to be sure. Take all the medications prescribed by your doctor (including any antibiotics and pain medications), and schedule an appointment to follow up with him within the first 2 weeks after the procedure (ask your doctor if you are unsure when to follow up).

          Make arrangements for someone to drive you home on the day of your discharge from the hospital.



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          ROBOT-ASSISTED LAPAROSCOPIC PYELOPLASTY OR URETERO PELVIC JUNCTION (UPJ) OBSTRUCTION REPAIR


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          About the Procedure:

          If the junction between the kidney and its drainage tube, the ureter, has a narrowing causing the flow of urine to be obstructed, this can sometimes be repaired in a minimally invasive fashion. Done laparoscopically, UPJ obstruction repair helps avoid a large incision, a long hospital stay, long recovery time, and offers more cosmetically appealing results.
          Additionally, the use of the robotic surgery platform allows your doctor to perform the procedure more quickly, exposing you and your kidneys to less stress and potential damage. This is accomplished through 3 to 5 dime-sized incisions in the abdomen. The procedure usually takes about 3 to 4 hours and you should expect to spend at least 1 night in the hospital. After the procedure, your doctor may leave a stent, or plastic drainage tube, in your body to help the repair heal. This will need to be removed by your doctor at a later date, so you must remember to follow up when you are scheduled to do so.

          Learn More about the Procedure


          Preparing for the Procedure:

          Take only clear liquids on the day prior to the procedure. Acceptable liquids include tea or coffee (no milk or cream), water, apple juice, Gatorade or other sports drinks, popsicles, italian ice, or chicken broth.

          Drink five ounces of citrate of magnesium at 4:00 pm the day before the procedure. If this does not produce a bowel movement by 7:00 pm take an additional 2 ounces of citrate of magnesium. This is available over the counter in the laxative section of your pharmacy. Remember to drink plenty of clear liquids to stay hydrated while preparing for your procedure.

          Do not eat or drink anything after midnight the night before the procedure. You should take your usual medications as you normally would the morning of your procedure with a small sip of water only (avoid juice, milk, coffee, etc.).

          Starting 5 to 10 days prior to your procedure (ask your doctor for a specific time), it is important to stop taking medications that might increase your risk of bleeding. For a list of blood-thinning medications that should be avoided, click here or ask you doctor.


          After the Procedure:

          There will be dressings on the incisions that can be removed on the second day after the procedure. After that, it is OK to shower (let soap and water run over the incision, then pat dry), but baths and soaking in a tub should be avoided for 2 weeks after the procedure. The incisions should be kept clean and dry to allow them to heal, so it is important to shower once a day. The incisions generally heal in five to seven days, but avoid any strenuous activity and exercise or heavy lifting for 4 to 6 weeks after the procedure. Your doctor will remove the surgical staples in your incisions at your first office visit following your discharge from the hospital. This is not painful and only takes a few minutes.


          It is usually OK to resume your blood-thinning medication the day after your procedure, but check with your doctor to be sure.Take all the medications prescribed by your doctor (including any antibiotics and pain medications), and schedule an appointment to follow up with him within the first 2 weeks after the procedure (ask your doctor if you are unsure when to follow up).


          Make arrangements for someone to drive you home on the day of your discharge from the hospital.



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          ROBOT-ASSISTED LAPAROSCOPIC RETROPERITONEAL OR PELVIC LYMPH NODE REMOVAL

          PDF download print version

          About the Procedure:

          In some men with testicular or prostate cancer, the lymph nodes in the abdomen or pelvis may need to be removed. This can be done in a minimally invasive fashion during a laparoscopic retroperitoneal lymph node dissection, which helps avoid a large incision, a long hospital stay, long recovery time, and offers more cosmetically appealing results. Additionally, the use of the robotic surgery platform allows your doctor to perform the procedure more quickly, exposing you and your kidneys to less stress and potential damage. This is usually done through 4 to 5 dime-sized incisions on the abdomen. The procedure usually takes about 3 to 4 hours and you should expect to spend at least 1 night in the hospital.

          Preparing for the Procedure:

          Take only clear liquids on the day prior to the procedure. Acceptable liquids include tea or coffee (no milk or cream), water, apple juice, Gatorade or other sports drinks, popsicles, italian ice, or chicken broth.

          Drink five ounces of citrate of magnesium at 4:00 pm the day before the procedure. If this does not produce a bowel movement by 7:00 pm take an additional 2 ounces of citrate of magnesium. This is available over the counter in the laxative section of your pharmacy. Remember to drink plenty of clear liquids to stay hydrated while preparing for your procedure.

          Do not eat or drink anything after midnight the night before the procedure. You should take your usual medications as you normally would the morning of your procedure with a small sip of water only (avoid juice, milk, coffee, etc.).

          Starting 5 to 10 days prior to your procedure (ask your doctor for a specific time), it is important to stop taking medications that might increase your risk of bleeding. For a list of blood-thinning medications that should be avoided, click here or ask you doctor.


          After the Procedure:

          There will be dressings on the incisions that can be removed on the second day after the procedure. After that, it is OK to shower (let soap and water run over the incision, then pat dry), but baths and soaking in a tub should be avoided for 2 weeks after the procedure. The incisions should be kept clean and dry to allow them to heal, so it is important to shower once a day. The incisions generally heal in five to seven days, but avoid any strenuous activity and exercise or heavy lifting for 4 to 6 weeks after the procedure. Your doctor will remove the surgical staples in your incisions at your first office visit following your discharge from the hospital. This is not painful and only takes a few minutes.

          It is usually OK to resume your blood-thinning medication the day after your procedure, but check with your doctor to be sure. Take all the medications prescribed by your doctor (including any antibiotics and pain medications), and schedule an appointment to follow up with him within the first 2 weeks after the procedure (ask your doctor if you are unsure when to follow up).

          Make arrangements for someone to drive you home on the day of your discharge from the hospital.



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