Sunday, July 06, 2008
Care of the Patient Undergoing Robotic-Assisted Prostatectomy
Operative and Postoperative Complications
As with any surgical procedure, there are potential complications to watch for when caring for the robotic-assisted surgical patient. The most obvious is the general operative risk associated with anesthesia. Many patients are otherwise healthy males, with no prior medical or surgical history, so it is impossible to predict exactly how they might respond to the anesthetic agents or pain medications. Patients with co-morbidities like heart disease, obesity, chronic obstructive pulmonary disease, diabetes, and hypertension are more likely to have postoperative problems.
Following abdominal surgery, development of a bowel ileus is always possible, so listening for bowel sounds is important in the early postoperative period. If no bowel sounds are noted, the patient is restricted to ice chips only. If bowel sounds are present, clear liquids may be started the evening of surgery, with transition to soft foods by the next morning, followed by a regular diet as tolerated.
Other potential postoperative complications include incisional infection, urinary tract infection, or urinary leak from the anastomosis site. Leaks are often detected when high-volume JP output is recorded over a short period of time. If this occurs, the urinary catheter can be placed on traction (by the surgeon or a trained member of the surgical team) and the leak will heal. If a urine leak is suspected, a creatinine level can be performed by the laboratory on the drainage fluid for a definitive diagnosis. Additionally, a cystogram could be done to visualize the location and extent of the anastomotic leak.
As the number of operative cases that a center performs increases, so does the potential for a range of complications. Centers with well over 100 robotic-assisted patients have reported a range of problems that include bowel injuries, ureteric injury, bladder injury, urine extravasation with leak, urinoma formation, intra-abdominal hemorrhage, lymphorrhea, phlebitis, and port site hernias (Basillote, Ahlering, Skarecky, Lee, & Clayman, 2004). It is important to remember that these are not common occurrences, but rather potential problems. Printer- Friendly Email This
Urol Nurs. 2006;26(2):129-136. ©2006 Society of Urologic Nurses and Associates
This is a part of article Care of the Patient Undergoing Robotic-Assisted Prostatectomy Taken from "Erectile Disfunction Medicine" Information Blog
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