The minimum delay between conducting prostate biopsies that have led to the diagnosis of prostate cancer and prostatectomy by laparoscopy assisted by the Da Vinci robot is around 6 weeks.
Prostate biopsies can lead to a local inflammatory reaction that is better resorbed.
Moreover, a certain amount of time is required for the completion of the examinations required for the extension test, in particular magnetic resonance (MRI) examination, which should not be performed too soon after biopsies for the same reason as Invoked above: the residual inflammation of the tissues can generate artefacts which can distort the interpretation of the images, and in particular the analysis of the integrity of the capsule.
This period is also the period during which the patient reflects and chooses the treatment he wishes among the different alternatives that have been proposed to him. In particular, he reviews his treating physician, who is the one who knows him best in his personal, physical and psychological dimension, but also in his family context. He can therefore usefully advise him on these different elements. It is also his / her attending physician who, within the framework of the coordinated care path, takes the necessary steps with the social security bodies to make it benefit from the exemption from co-payment.
This period of 4 to 6 weeks between the diagnosis of prostate cancer and the robot-assisted radical prostatectomy does not put the patient at risk of seeing his curable condition evolve into an outdated form because the progression of prostate cancer is usually Relatively slow.
Conversely, the maximum delay between biopsies, the completion of the extension report and the intervention must not exceed a few months. Beyond that there is a risk that the information collected on the degree of evolution of the cancer by the analysis of the result of the biopsies and the extension of the balance (MRI) and from which was indicated the indication of the curative treatment Are null and void.
What preparation before robot-assisted prostatectomy?
The preparation of the prospective surgery for root-assisted radical prostatectomy has few peculiarities compared with that of a usual pelvic intervention, and in particular compared to that of conventional prostatectomy by the open method.
The intervention is always preceded by a compulsory pre-anesthesia consultation, which must take place at least 48 hours before the patient is admitted to the clinic.
In fact, it is preferable that this delay is more important because the anesthesiologist performs a complete evaluation of the patient’s condition, in particular cardiovascular and respiratory, and he may need, due to the existence of pathologies (Cardiologist, diabetologist etc …) or to ask for specialized opinions or explorations (carotid doppler, exercise electrocardiogram, etc …).
The pre-anesthesia consultation also allows the anesthesiologist to make certain necessary adjustments regarding the treatments regularly followed by the patient.
This is especially important before surgery for drugs that alter blood clotting, including anticoagulants, aspirin, and platelet anti-aggregants. Finally, this consultation allows the anesthesiologist to agree with the patient on the mode of anesthesia, in this case for prostatectomy by robot-assisted laparoscopy Da Vinci a mandatory general anesthesia, and to inform him of its advantages, disadvantages and possible risks .
The preoperative examinations necessary and to be carried out externally are usually limited to a cyto-bacteriological examination of the urine, the final result of which may take several days, as it is necessary to ensure the absence of urinary infection before performing this surgery .
All other biological examinations are performed at the clinic at the patient’s admission the day before surgery, as well as the preoperative electrocardiogram and examination by a cardiologist at the facility. Radiography of the lungs has already been performed with the extension test.
Before the intervention, we refer the patient to a physiotherapist specializing in urinary rehabilitation, so that he assesses the quality of the sphincter and the perineal musculature of the future surgeon and especially so that he learns from the occasion 4 or 5 sessions the movements of perineal gymnastics that it will have to practice in the postoperative suites so as to recover as quickly as possible a good continence.
We believe that it is easier at this time to learn these movements correctly than after the intervention, while the sensitivity of the operated pelvic region and the perineum is modified.
A diet without residue to prepare the intestine completes this pre-operative phase but even in case of significant excess weight, we do not practice dieting to the patient.
Obesity, though it is never an asset in surgery as it makes the surgical gesture more difficult and hemorrhagic, is a lot of annoying months for the surgeon in robot-assisted laparoscopy than during an open surgery.
The last precaution is to have the patient buy compression socks that he / she will wear during the procedure and in the weeks that follow.
It is a simple and safe measure that participates in the prevention of venous thromboembolic disease with its well-known risks of lower limb phlebitis or even pulmonary embolism.