From Charlie’s Story Part I:
Given my circumstances (prostate cancer), one of the options was ‘watchful waiting’ and that was the course that we all agreed was appropriate. BUT this would mean more biopsies.”
Plumbing: Robotic Assisted Surgery for Prostate Cancer
When your doctor informs you that you have prostrate cancer your first thought may be of your male plumbing, but later your thoughts may change. Perhaps you will think that your medical condition has you trapped like a prisoner in an Edgar Allen Poe story.
Imagine a person held by the Inquisition and sentenced to a dungeon where unseen and unknown dangers lurked. Imagine further a dungeon and prisoner’s horror as he lies bound on the rack and the sharpened pendulum blade swoops back and forth as it lowers toward his defenseless body:
“Still I quivered in every nerve to think how slight a sinking of the machinery would precipitate that keen, glistening axe upon my bosom. It was hope that prompted the nerve to quiver — the frame to shrink. It was hope — the hope that triumphs on the rack — that whispers to the death-condemned even in the dungeons of the Inquisition.”
—Poe, The Pit and the Pendulum, 1842
The Poe classic horror story still has the power to chill a reader after 170 years. But other than being confined, nothing physically happens to the prisoner. There are no cuts or bruises to cause pain, the pain is from the terror the prisoner feels in his mind.
A man may feel similar terror and helplessness when first diagnosed with prostate cancer. All the preconceptions and misconceptions one has about cancer may pass through his mind. He may feel that fate has deserted him, that his position is hopeless.
In Poe’s story hope allows the prisoner to eventually triumph, and he can then explore his prison rationally to look for relief. The situation is not unlike that of the prostate cancer patient—there is time to think because the cancer is slow growing.
Prostate cancer cannot now be reversed, hope for cancer patients lies in selecting the right treatment options. The National Institute of Health calls the “watchful waiting” approach a treatment option that may safely postpone the other invasive and irreversible options of radiation or surgery.
However, while watching and waiting, discomfort and pain may occur even though the periodic biopsy and PSA tests indicate that the cancer is neither growing nor spreading. However, the prostate enlarges slowly with age, which may cause incontinence leading to a Urinary Tract Infection. A UTI may make normal activity impossible and may point toward a change in treatment for the cancer.
A Urinary Tract Infection eventually led our guest blogger, Charlie, into giving up watchful waiting. Let’s continue his story and see what happened:
“Over the next 6 years Dr S closely monitored my PSA level, did regular examinations and I suffered through more biopsies. I was never able to count to 12.
Oh, I forgot to tell you that during all this time I had an enlarged prostate that continued to get bigger which means I began to dribble, and I would get up 2, 3, 4 times a night. It took so long to go that I began sitting down at the toilet. I figure that over a period of 6 years I spent over 500 hours sitting on the toilet at night waiting and trying to go.
Finally, a UTI (front hole infection) sent me to the emergency room and I had to have a catheter put in.
It was time for me to do something: more “watchful waiting” was going to mean more frequent biopsies and UTIs.
I called Dr S and we scheduled the surgery. The medical name is a radical prostatectomy using a robotic da Vinci surgical device.
The operation involves 5 very small incisions versus an 8 to 10 inch incision for the usual prostrate surgery.”
During the 6 years Charlie monitored his prostate cancer there had been great improvements in robotic assisted surgery to remove the diseased prostate. Surgeons use robotic assisted procedures in 60% of all prostate surgeries.
The leading robotic surgery system is the da Vinci system, which was developed by SRI International of Menlo Park, CA. In 1995 SRI formed Intuitive Surgical, Inc. to commercialize its revolutionary robotic surgical technology. Five years later, the government approved the da Vinci system for use in surgery, and according to SRI:
“Today, Intuitive Surgical (Nasdaq: INTU) and its da Vinci Surgical Suite is the market leader in robotic surgery, with nearly 300 da Vinci Systems installed in hospitals worldwide. Surgical patients around the globe are benefiting by recovering more quickly, with less pain and fewer complications.”
A da Vinci system is installed at the hospital where Charlie is going for treatment, and his doctor is trained in its use. Let’s see how the operation worked:
“I was scheduled for a pre-op check of my bladder. This doesn’t sound too bad – right?
A very good friend of mine had had this same pre-op & surgery done a couple of years earlier by Dr. S so I called him.
He told me about a nurse he called ‘Broom Hilda’:
‘Broom Hilda came in, grabbed my [front hole appendage], squirted Novocain down the front hole, and inserted a scope and then the doctor looked around.’
Hearing this, I almost passed out.
The day came and I waited for ‘Broom Hilda’ to call on me but to my surprise and relief there was a nice, very gentle (if you catch my drift) nurse from pediatrics subbing for ‘Broom Hilda’.
The procedure wasn’t that bad. I’d take one of these any day over a biopsy.
Surgery day arrived.
The surgery was scheduled for 1PM. I register, am taken to the pre-op area, strip, get my Johnnie gown on. Then lots of different people start asking me questions while a nurse sticks an IV needle in my arm. They have me read a disclaimer about all the bad things that could happen during the operation (I mean REALLY bad). This makes you really comfortable about what’s to take place.
Dr S comes in and says he’ll see me in surgery. Then a nurse comes in and puts a silver cap on my head. I thought that they had run out of the blue and green ones. I found out later that a silver cap means the surgery is going to take a long time to complete.
I wait, and then someone comes in and says it’s time to go and starts to push my gurney to the operating room. It was a long distance with many turns, one of which was wrong so he had to turn my gurney around in the hallway. Was this a bad sign? I finally arrived and there was my anesthesiologist so I said Hi – that’s the last thing I remember.
Seven hours later I was wheeled from surgery back to my room.
Dr S had spoken with my wife a couple of hours earlier and told her that all had gone very well and that everything looked very good. She saw me in the recovery room after surgery and said that my head looked like a balloon (I had been tilted head down during the seven hour operation so all my innards would vacate the surgery area). My stomach looked like a balloon too since they had inflated the area around the prostate with gas to make room for the robotic tools.”
I’ll stop here, and pick up Charlie’s story in a moment, but first let’s recall the ending of Poe’s story:
“I struggled no more, but the agony of my soul found vent in one loud, long, and final scream of despair. I felt that I tottered upon the brink — I averted my eyes — There was a discordant hum of human voices! There was a loud blast as of many trumpets! There was a harsh grating as of a thousand thunders! The fiery walls rushed back! An outstretched arm caught my own as I fell, fainting, into the abyss. It was that of General Lasalle. The French army had entered Toledo. The Inquisition was in the hands of its enemies.”
—Poe, The Pit and the Pendulum, 1842
From the depths of despair, Poe’s prisoner is saved and the Inquisition defeated. Hooray for up-beat endings!
Well it seems that Charlie’s story may have an upbeat ending also, but let’s read what he says:
“My recovery from the operation was slow. I first had to pass the gas that they blew into me and I had to be able to eat and move the food through my system.
The next morning I was lying there awake (not a restful night) when a young, very nice, pretty nurse comes in and tells me she is going to show me how to properly care for the catheter line. She pulls down my covers, lifts my Johnnie gown up and gently shows me how to clean my catheter line and my front hole with antiseptic pads. This was a new experience.
How quickly all modesty is lost and, you know, you don’t care at all.
The friend I mention earlier had been discharged the next day after his operation, but since I can’t count to 12 or pass gas, I waited 5 days before I was discharged. I do have to say that the staff (RNs, LNAs, aides, etc.) was great.
On arriving home, I had been thinking that chicken noodle soup would taste pretty good for lunch and I hoped there was a can in the pantry. Well, we came in the door and our daughter had just finished making homemade chicken noodle soup and a batch of chocolate chip cookies.
Two hours later my 4-year-old granddaughter arrived with a card she had made all by herself that said “Get Well Pop Pop” with lots of super hero stickers.
I knew that I was on the road to complete recovery.
My wife & I had been given instructions in the care of the catheter bag (note that this is different from the cleaning of the catheter tube that comes out of your front hole).
She was about to become more familiar with me (even after 42 years of marriage) by helping me get up and dressed, switching/cleaning catheter bags, changing dressings, helping me up at night to pass gas, helping me take my first shower, and getting me dressed (the list could go on and on).
What can I say other than ‘I love her’,
and she must REALLY love me to do all of this.”
Good luck Charlie. Thanks for the story.
You may want more information about the treatment for Prostate Cancer and videos of the actual use of the da Vinci system at the Fletcher Allen hospital at the University of Vermont: prostate cancer treatment.
Day 77: The Pit and the Pendulum (eBook, first published in: The Gift: A Christmas and New Year’s Present for 1843), Edgar Alan Poe (1842).