For most patients, robotic-assisted prostate surgery offers substan-tially less pain, less blood loss and a much shorter recovery. Other advantages include reduced need for blood transfusions, minimal scar-ring, less risk of infection, shorter hospital stays and quicker return to normal activities.

naveen kella, mddirector, robotic urologic oncology urology San antonio

Q. Who is a candidate for robotic surgery? A. men whose disease is encapsulated in the prostate (has not spread) are likely candidates for robotic prostate surgery. Patients who have had prior radiation treatment (seeds or external beam) for prostate cancer are not candidates for the robotic approach.

Q. Where are the incisions? A. The diagram shows the dime-sized incisions of the robotic procedure. Four incisions are for the robot’s “arms,” and the fifth is for the camera probe. This incision is made slightly larger than the others so that the urologist can extract the prostate specimen at the end of the procedure.

common QuestionsGENERAL QUESTIONS Q. How does robotic prostatectomy compare with traditional “open” prostatectomy? A. robotic prostatectomy requires only dime-sized incisions, and patients usually recover within 2-3 weeks, whereas traditional prostate surgery requires a 6-8 inch incision, and recovery may take a month or longer.

Q. Does the robotic prostatectomy result in a higher cure rate than conventional surgery? A. The cure rates for both procedures are very high; however, because of its precision, the completeness of cancer removal may be higher with robotics. our data shows favorable results, even when compared those of proficient open surgeons. also, the return of bladder control and preservation of erectile function may be better with the robotic approach.

ProState SurgeryROBOTIC

Open Prostatectomy Incision da Vinci Prostatectomy IncisionsOpen Prostatectomy Incision Robotic Prostatectomy Incision

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Q. How long does the surgery take? A. barring unusual circumstances, most surgeries are completed in about 1.5 hours. additional time is needed for patient positioning, anesthesia and recovery. The evening after surgery, most patients are walking or sitting comfortably in a chair in their hospital room.

Q. How long will I stay in the hospital? A. over 85 percent of patients leave the hospital within one day of their surgery.

The daVinci S is the newest, most advanced robot model available.

Q. Where is the surgery performed? A. dr. kella performs surgeries at St. luke’s baptist Hospital. The staff at this facility has been specially trained to assist in performing robotic prostatectomy and to tend to the patient’s post-surgery needs.

Q. Exactly what type of robot technology is used? A. We utilize the newest model robot, the davinci S manufactured by intuitive Surgical. This second generation surgical system offers the doctor a wider viewing field displayed in high definition. improvements to the surgical instruments and their controls allow the physician to operate with more ease than ever before.

Q. How safe is the robotic procedure? A. Since he began performing the procedure in 2004, dr. kella has never observed a robot malfunction that has caused a case to be aborted. in general, the robot is as safe as the person operating it, but should something unforeseen occur, equipment is available to convert the case to a traditional prostatectomy or a regular laparoscopic (minimally invasive) prostatectomy.

Q. When can I return to work? A. many patients can return to desk work in 7-14 days. due to the low number of complications, long-term medical leave is unnecessary in most cases.

program at baylor college of medicine in Houston where he worked with leading experts in the clinical research and surgical treatment of prostate cancer.

Q. Does the robotic procedure cost more than traditional prostate surgery? A. most insurance companies cover the Fda approved robotic prostatectomy procedure, and in the majority of cases the cost to the patient is the same as traditional prostate surgery. For assistance verifying your specific insurance benefits or information for cash paying patients, call our billing and insurance department at (210) 731-2050.

Q. How experienced is my doctor with this procedure? A. dr. naveen kella performs 6-9 robotic cases each week, making him one of the top fifteen most experienced robotic surgeons in the nation. dr. kella is recognized in the medical community for his expertise and is called on to train surgeons from across the nation. He frequently attends robotic surgery meetings and has observed some of the world’s best surgeons perform the procedure. in addition, dr. kella completed a year-long robotics and oncology fellowship

Dr. Kella has performed more than 775 robotic radical prostatectomies and is the only urologist in the region who is fellowship-trained in robotic procedures and urologic cancers. Each month, Dr. Kella completes 25 or more robotic procedures, making him is one of the nation’s most experienced robotic surgeons.

robotic ProStatectomy: common QueStionS, 3/5

Q. My urologist is unsure of the benefits of robotic surgery. Is it really worth it? A. all of our experience and the latest studies in the literature strongly support the usage of robotics to improve the outcomes in patients. extremely low blood loss, smaller incisions, and precise, magnified movements all mean a faster, better recovery.

• Saturday evening or Sunday morning: barring any complications, you will be discharged from the hospital • Following Thursday: meet with dr. kella again at his office. at this time, he will remove the urinary catheter and review the pathology report with you. We recommend you stay in San antonio overnight in case you have difficulty emptying your bladder after the catheter is removed. • Follow-up care: you are welcome to return to San antonio for routine PSas and ongoing follow-up care, or you may see your hometown urologist.

Q. Where do you recommend I stay if I am traveling to San Antonio? A. many hotels and motels in all price ranges are located within a two or three miles of our clinic and the hospital. For a list of some of these facilities, visit the customer Service section of www.urologysanantonio.com or contact Joyce reyna in the business office at (800) 798-5111.

When you call to make your reservation, be sure to inquire about medical discounts and complimentary transportation to and from the airport and medical facilities.

PRE-SURGERY QUESTIONS Q. Should i donate my own blood before surgery? a. one of the many benefits of robotic surgery is minimal blood loss. less than half of one percent of dr. kella’s patients have ever need blood products, and it is not necessary to donate your blood.

Q. Is exercise or dieting a good idea prior to surgery? A. yes! in the weeks before surgery, try to increase your exercise and improve your diet as much as possible. This can greatly improve the speed of your recovery after surgery. losing a few pounds may also help your surgeon perform your operation more smoothly.

Q. When do I stop my medications? A. our office will mail you a list of medications that you must stop taking prior to your surgery. Please review the list and follow the instructions indicating when to discontinue and restart your medications.

Q. Can I talk to other patients about their experience? A. definitely. call Hortencia in the surgery scheduling department at (210) 614-4544 ext. 1018 and she will provide you with the names and contact information of patients who are willing to talk about their experience with robotic prostatectomy.

Q. I am from out of town. What can I do for treatment? A. Physical distance should not be a barrier to receiving the best medical care available. dr. naveen kella has treated numerous patients from outside San antonio and even outside the united States. our team is happy to help you make accommodations to fit your lifestyle and budget.

out-of-town patients should expect to stay in San antonio for a total of 8 days. typically, the schedule is as follows…

• Prior to arrival: review and comply with list of medications patients must stop taking prior to surgery • Thursday: meet with dr. kella at his office; undergo lab tests (if necessary); begin bowel prep. • Friday: undergo surgery

robotic ProStatectomy: common QueStionS 4/5

Q. Where do I get the pre and post surgery prescriptions that the surgeon prescribed? A. The bowel preparation and post-operative prescriptions will be mailed to you in prior to surgery. instructions for filling these prescriptions will be included.

Q. Will I be able to father children after surgery? A. no. The procedure will allow you the potential for erections, but your ejaculations will be dry.

POST-SURGERY QUESTIONS Q. When will I be able to resume normal activities? A. The major advantage of robotic prostatectomy is decreased bleeding and decreased pain, which results in quicker recovery. most men undergoing this operation are able to resume normal activities within 1-2 weeks after surgery. Strenuous activities like running or weight lifting should be restricted until 4 weeks after surgery, and riding a bike, motorcycle, or horse must be avoided for 2 months. listen to your body, and do not “work through the pain.”

Q. When will I be able to eat? A. Some patients report feeling bloated for the first 24-36 hours after surgery. For this reason, wearing pants with elastic waists may be more conformable. While in the hospital, you may have liquids and soft solid foods and a regular lunch on the afternoon after your procedure. broccoli and other gas-producing foods should be avoided until the bloating has subsided. also, avoid steaks and other red meets until you are able to pass gas from your rectum.

Q. When can I resume taking my normal medications and vitamins? A. dr. kella will tell you when to resume taking your medions.

Q. How do I care for the urinary catheter? A. The nurses at the hospital will explain the ways to care for your catheter.

Q. When is the urinary catheter removed? A. another advantage of robotic prostatectomy over

traditional prostatectomy is the early removal of the urinary catheter—usually 6-8 days after surgery. remember to bring a pair of brief-style underwear and some depends guards for men to the appointment, as you will be temporarily incontinent after the catheter is removed.

Q. How soon after surgery can I expect to regain urinary control? A. men who undergo robotic surgery at the hands of an experienced surgeon regain continence quicker than men who undergo traditional prostatectomy. twenty-five percent of men who undergo the robotic procedure have full urinary control and do not need pads within one week after the catheter is removed. eighty percent of patients report that they are continent within 3 months, and at one year, over 90 percent of patients have regained bladder control.

Q. What are Kegel exercises? A. a kegel is a pelvic floor exercise, named after dr. arnold kegel who invented the exercise. The pelvic floor muscles are attached to the pelvic bone and act like a hammock, holding in the pelvic organs. exercising or strengthening these muscles helps restore the bladder control after the catheter is removed. urology San antonio’s state-of the-art continence center has a dedicated nurse practitioner who can work with you on a pelvic floor rehabilitation program to speed resumption of urinary control.

Q. Will I be able to have normal sexual relations after surgery? A. resumption of sexual activity depends strongly on your potency before surgery and the surgical technique used. The robot is an incredible tool, but it is only as good as the surgeon performing the procedure. not everyone can expect a return of activity, but an aggressive rehabilitation protocol is available to patients hoping for a return of function. as part of their rehabilitation, patients may consult with leroy a. Jones, m.d. or William P. Fitch, m.d., urology San antonio physicians who specialize in the field of men’s sexual medicine.

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Q. When do I return to see the surgeon? A. your first follow-up appointment will be 6-8 days after surgery. at this time, the doctor will remove your urinary catheter, examine your incisions, review the information gained from analyzing your prostate specimen, and formulate a plan for cancer surveillance.

after your first post-operative visit, you will continue to follow up with your urologist every three months for the first year. at each appointment, your urologist will draw your PSa to verify that the cancer has not returned.

Q. What if my prostate cancer recurs? A. as with any cancer treatment, there is always a risk that the disease will recur. your urologist is alert for signs of recurrence and utilizes scientifically proven computerized tools to determine your risk for recurrence. These tools, called nomograms, incorporate a combination of diseases factors including the stage of the cancer, PSa level, and pathology. if your nomogram results indicated a high risk of cancer recurrence, your doctor may recommend intensity-modulated radiation therapy or imrt, the most advanced form of external beam radiation therapy. Patients may also have access to the latest and most promising treatments for recurrent prostate cancer by participating in clinical trails at urology San antonio research.

CENTER FOR PROSTATE CANCER TREATMENT Naveen Kella, MD Board-certified Urologist Director, Robotic Urologic Oncology 7909 Fredericksburg Rd, Suite 120 San Antonio, TX 78229 (210) 614-4544 •(800) 798-5111 www.urologysanantonio.com • www.roboticsurgerysa.com

Updated 10.22.2008