In a first step, the abdomen is filled with carbon dioxide gas via the first small access situated slightly above the navel. Then the insertion of the camera is carried out with the aid of a trocar. Subsequently, additional trocars are placed.
At the beginning of the operation, the prostate is carefully exposed and separated from the bladder. Subsequently, the seminal vesicles are exposed and the seminal ducts are cut. Afterwards, the prostate pedicles, which secure the prostate in its position, are cut. If the characteristics of the tumor allow for the nerve- sparing procedure, the neurovascular bundles are separated from the prostate. The fine nerves are easily visible with the three-dimensional depiction and the tenfold enlargement of the camera images. They are then removed from the prostate with completely hand-tremor-free movements.
After completion of the nerve-sparing procedure, the prostate is separated from the urethra. A technique which was developed by doctors of the Martini-Klinik is used which completely spares the urethral sphincter muscle in order to maintain the patient’s continence. Thus, the entire prostate has been fully detached, and it is removed from the body via one of the trocar incisions.
In order to guarantee that the nerves are spared, frozen sections are – depending on the respective tumor characteristics – performed on those parts of the prostate which are directly adjacent to the nerve cords (NeuroSAFE-technique). During anesthesia, these frozen sections are microscopically examined by a pathologist in order to ensure that the nerve-sparing procedure can be performed without risk to the patient.
Subsequently, the urinary bladder is reconnected with the urethra. The bladder-urethra connection can thus be sewn together completely watertight. In this procedure, as little tissue of the sphincter as possible is included in the stitches in order to spare the tissue for continence.
Finally, the trocars are removed; where necessary, a surgical drain is inserted. The operation is concluded with the closing of the wound.
Almost every patient's nerves are protected during operation to preserve the erectile function. This is not possible if single cells of the tumor have already spread to the nerves, which are delicately attached to the prostate gland's sides. As the only clinic in Germany, the Martini-Klinik investigates during the operationwhether the sides of the gland, touching the nerves, contain cancerous cells (Neuro-Safe-Technique).
Based on this finding it is then decided whether the nerves on both sides can be preserved or have to be removed. By this procedure, developped in the Martini-Klinik, 88 to 99 % of patients, depending on the tumor stadium (97 % in total) could undergo this nerve preserving procedure.
The Martini-Klinik offers the reliable operation techniques of the open operation (radical retropubical prostatectomy) and the da Vinci robot-assisted removal of the prostate. Together with you we decide which operation method meets your individual needs best.
The necessity of a blood transfusion after the operation is very low (3 - 5%). Therefore, patients who donate blood before theoperation do so for no reason and are weakend before the operation. For this reason, we do not advise to donate one's own blood beforehand.
Luckily, the infection rate is very low in our clinic. Consequently, the rate of infections with multi-resistant germs is rather low. The reason for this lies in the specialization of the clinic. Moreover, strict strategies of precaution concerning these infections are being met at the Martini-Klinik.
The stationary stay takes about a week.
We predict about 2 to 3 weeks for further recovery after discharge from our clinic. After this time, you are usually recovered to take up your daily procedures.
Yes, during every operation method a catheter is inserted. In general, it remains for one to two weeks after the operation.