It’s a robot-assisted laparoscopic radical prostatectomy. The robot-assisted part of that title is a bit of a misnomer because it does not involve a true robot in the sense of a machine that has volition and programming of its own. It’s a so-called master/slave system. So if you can picture it, essentially what it entails is a surgeon sitting at a computer console a little like a very expensive child’s computer game console but worth a few more million quid than an average child’s game. Other assisting surgeons will make small incisions, in total 6, sorry 5 incisions are involved for a variety of ports to be inserted with implements or in effect binoculars attached to them.

Those ports are manually inserted by the assisting surgeons and once inserted, the principal surgeon takes over. The principal surgeon is in the operating theatre although in theory given the wonders of modern technology the surgeon could be on a different land mass or a different continent operating on somebody. But in practice of course the surgeon is in the same operating theatre and what he or she would be looking at is a 3-D image on screen of what the robot ports inside the patient’s abdomen are seeing.

And the surgeon is able to manipulate the various robotic ports that have been inserted into the patient and is able to do so having scaled up or down his or her movement relative to the robot’s movements. So in effect put, put simply you can task the robot to say let every two millimetres of my hand’s movement equal 0.2 mm of the robotic arm’s movement so that you can thus get extreme precision of movement guided by a 3-D image that the surgeon is seeing on screen. What the robotic device will also do is eliminate any manual tremor that might otherwise be there for a surgeon. And this of course is part of why I was drawn to this procedure in the first place. If you’re tinkering around crucial nerve bundles that are responsible for amongst other things, erectile function, I was very drawn to the idea of great precision of movement with no tremor. So essentially it’s a master/slave robot system, manually assisted insertion of the robotic ports and then the principal surgeon takes over on the computer console.

It’s a robot-assisted laparoscopic radical prostatectomy. The robot-assisted part of that title is a bit of a misnomer because it does not involve a true robot in the sense of a machine that has volition and programming of its own. It’s a so-called master/slave system. So if you can picture it, essentially what it entails is a surgeon sitting at a computer console a little like a very expensive child’s computer game console but worth a few more million quid than an average child’s game. Other assisting surgeons will make small incisions, in total 6, sorry 5 incisions are involved for a variety of ports to be inserted with implements or in effect binoculars attached to them.

Those ports are manually inserted by the assisting surgeons and once inserted, the principal surgeon takes over. The principal surgeon is in the operating theatre although in theory given the wonders of modern technology the surgeon could be on a different land mass or a different continent operating on somebody. But in practice of course the surgeon is in the same operating theatre and what he or she would be looking at is a 3-D image on screen of what the robot ports inside the patient’s abdomen are seeing.

And the surgeon is able to manipulate the various robotic ports that have been inserted into the patient and is able to do so having scaled up or down his or her movement relative to the robot’s movements. So in effect put, put simply you can task the robot to say let every two millimetres of my hand’s movement equal 0.2 mm of the robotic arm’s movement so that you can thus get extreme precision of movement guided by a 3-D image that the surgeon is seeing on screen. What the robotic device will also do is eliminate any manual tremor that might otherwise be there for a surgeon. And this of course is part of why I was drawn to this procedure in the first place. If you’re tinkering around crucial nerve bundles that are responsible for amongst other things, erectile function, I was very drawn to the idea of great precision of movement with no tremor. So essentially it’s a master/slave robot system, manually assisted insertion of the robotic ports and then the principal surgeon takes over on the computer console.

At the new hospital, the biopsy was a trans-perineal, I think it’s called,biopsy, which takes twenty four samples instead of twelve, and it was quite a painful experience, and there was a lot of blood and the outcome of it was that it revealed what the first biopsy hadn’t revealed, which was that the cancer was right in the centre of the prostate and it was fairly advanced, so as a result I was told that brachytherapy would have been the very worst possible treatment for me because it wouldn’t have been possible to have surgery after the brachytherapy, because of the amount of scar tissue created by the brachytherapy, so there was only one option which was a prostatectomy. The hospital I was at now, it was able to offer robotic laparoscopic prostatectomy, so I was, referred for an operation and so it had been quite a long process from seeing the GP at the, where I was originally living in August 2008 to being operated on in April 2009.

I was sent for a pre-operative assessment in late March so just a couple of weeks before admission for height, weight, blood pressure, assorted blood work and other analysis to be done to make sure that there was nothing that would stand as an obstacle to my admission for surgery. That was all fine, so the admission went ahead.

I was admitted on the Thursday the 12th of April 2007, the day before surgery. I was, I underwent surgery then on the rather inauspicious date of Friday the 13th of April but of course I don’t believe in superstition because I think it brings you bad luck.

The operation was a great success, it was, I thought the surgeon was fantastic, everything was really great, my PSA since then has been, undetectable, the hospital treatment wasn’t great, the ward was, chaotic, it was very difficult to tell who was what, the cleaners wore the same uniform as the surgeons, but you know, you’re there to be treated and you go through it and it was just great to know that it was out of my system, it was a really good feeling,

Post operation I had a catheter for about ten days, again that was a little bit chaotically organised, I know other people who’ve been through the same experience and they’ve come home with pads, and catheters and a stand to put the catheter on at night, and I had none of that, and nobody really seemed that bothered about helping out, so I had to kind of sort it out for myself, the catheter I hated, it was very uncomfortable, very difficult walking around, I was able to walk, reasonably, the day after I got home, I went out for a short walk, walking very very slowly, quite unsteady, but things improved fairly rapidly and once the catheter was removed then I progressed fairly quickly.

The two principal side effects were firstly, incontinence I had to wear incontinence pads, I was wearing quite large pads, and getting through a couple a day, two or three a day to begin with, things improved over the course of the first six months I suppose, I was doing pelvic floor exercise, perhaps not as consistently as I might have done but they helped, but then it’s, it reached a plateau, I was, after that point I was going back to the hospital every six months, for a check up which consisted of a PSA test and a chat about my condition generally, and after the first two or three perhaps of those assessments I had… the guy I saw had been trained and was operating on male slings which reduce incontinence and he thought that I was an ideal candidate for that, so I had a test for that, which was basically to see the capacity of my bladder and the amount of leakage, and they decided that because I wasn’t too severely incontinent that I was a good candidate for that so I was put forward for that second operation, which took place just about two years after my prostatectomy. I had the operation under, I had the choice of local anaesthetic or a general anaesthetic, and I chose a local because I don’t like anaesthetics very much, the operation was quite straightforward, quite quick, I went home the following day. It was incredibly uncomfortable, the operation is basically you’re, you’re cut open, right underneath, right underneath the bit you sit on, which made it very difficult, when I got home, very difficult to get comfortable, difficult at night, difficult when you are sitting down, and difficult walking, the first couple of weeks were pretty uncomfortable, it was, I would say it was, that the operation was worth doing because the incontinence was reduced, but I had rather hoped that I’d be completely free and in control of, that aspect and free of having to wear pads, but it wasn’t, things were a lot better, I wear one smaller pad now, and I don’t have to worry so much about it, I don’t have to worry about making sure that I’m within reach of a loo so I can change my pad when I go out in the evening or anything like that, so from that point of view it’s been very beneficial, not as good as I would have hoped.

And have you been told that that will get better, or will that be the level of incontinence?

It [urinary incontinence] may still get better, because the, the way the male sling works it’s, I believe it’s attached to the pelvic bone at either side, and then it just flops underneath the bladder, but in the course of putting it, or in the course of fitting it, there is scar, operation surgery damage which creates scar tissue and the scar tissue actually [lights go out] strengthens the sling so that over the course of time the sling actually gets stronger.

The sling gets stronger?

The sling gets stronger, so there is hope, I’ve been told that over, perhaps the first year, there, there is certainly a possibility that things will get better, and I’m trying to help myself a bit more now and doing pelvic floor exercises which definitely do help and I notice that if I go a day or two without doing the exercises, then things get worse. So I really should be doing them several times a day, and I should be drinking less coffee than I do, but I like coffee andlike to have a pint sometimes in the evening, and one puts up with the consequences.