As the world continues to adapt to life in the midst of the COVID-19 pandemic, it’s more important than ever for medical professionals to adapt their procedures to keep patients as safe and healthy as possible. UCA is one of the first practices to unveil outpatient robotic prostate cancer surgery as an option for select patients. Dr. Charles Bugg played a critical part in advancing this robotic surgery protocol so patients are able to be discharged from the hospital the same day and safely recover at home. Dr. Bugg has been performing robotic surgeries since 2002 and has helped modify the robotic surgical technique to improve cancer removal, urinary control and maintain erectile function. We sat down with Dr. Bugg to discuss the ins-and-outs of outpatient robotic surgery and the many benefits this procedure offers patients.

Q: How would you describe an outpatient robotic prostate cancer surgery vs. a standard inpatient surgery? Did COVID-19 have any impact on the advancement of this surgical procedure?

A: Our robotics program at UCA has evolved over the past 18+ years since we started using robotic surgery back in 2002. Our robotic surgery program is very protocol-driven — from all the pre-operative work to surgical technique to post-operative follow-up care. Historically a patient would undergo a surgical procedure such as a prostatectomy and need to stay in the hospital for at least one night, sometimes more.

When the COVID-19 pandemic hit, we could not admit patients to the hospital since there were no beds available; subsequently, cancer patients were forced to delay care. At UCA, we decided to push for outpatient prostate surgery, which allows the patient to receive the surgery and go home that same day. Although our surgical protocols have stayed the same, the timeline for the immediate postoperative recovery has been modified so the patient can leave the hospital and recover in the comfort of their home without compromising outcome.

Q: Would you describe a robotic prostatectomy as a minimally invasive procedure?

A: Robotic prostate cancer surgery is a major surgery with a minimally invasive approach. Robotic surgery is a type of laparoscopic surgery which uses small instruments to do the same type of surgery as an open approach but avoids large incisions. Robotic surgery offers a number of advantages over standard laparoscopic surgery. Robotic prostatectomies usually require at least one overnight stay in the hospital, but with our outpatient approach, we can now send patients home the same day of their surgery.

Q: Are there any common misconceptions about robotic surgery that you hear often from patients? What would you like the public to know about these misconceptions?

A: Early on in robotic surgery, there were a lot of doubts regarding how accurate and effective a robotic surgery would be compared to the traditional open surgical approach. Over the years, we’ve found that we can do a much better job using robotic surgery than we could using traditional open surgery. Robotic surgery provides better visualization and more precise dissection which results in excellent cancer control, faster patient recovery, less blood loss and better preservation of urinary control and erectile function.

Q: What is the biggest advantage of outpatient robotic surgery?

A: The main benefit of outpatient vs inpatient surgery is that it is oftentimes more convenient and comfortable for the patient since they can recover in their own home. By eliminating the overnight(s) stay, cost is decreased. Another major benefit is it reduces their exposure to possible infections that they may encounter while lodging overnight at the hospital.

Q: Can you describe the recovery process following an outpatient robotic surgery?

A: The protocols are the same as our traditional inpatient robotic surgery; prior to discharge, we still want to see patients ambulate, tolerate liquids, report satisfactory pain control with oral medication, etc. We also follow up with the patients over the phone to verify they are recovering as expected. We’re not changing anything we normally do as far as protocol, we just do it earlier with a more efficient timeline.

Q: What does the future of outpatient robotic surgery look like in your mind?

A: We expect robotic surgery will continue to branch off into many fields and be utilized more widely. As we enter more into the world of artificial intelligence and advancing technology, I think we will continue to see more options and improvements, such as better remote surgery. As technology improves, I think the robotic surgery field will continue to evolve and change for the better.