What is robotic radical prostatectomy? All you need to know

Robotic radical prostatectomy is a highly effective and minimally invasive treatment option for prostate cancer. This surgical approach, which utilises cutting-edge robotic technology, offers numerous benefits over traditional methods.

When is robotic radical prostatectomy indicated?

Robotic radical prostatectomy is primarily indicated for patients diagnosed with localised or early-stage prostate cancer. This means that the cancer is confined to the prostate gland and hasn’t spread to other parts of the body.

The other indication for the procedure is if a patient has prostate cancer that hasn’t responded to other cancer treatments, such as radiation therapy.

How is robotic radical prostatectomy performed?

A robotic radical prostatectomy is a minimally invasive surgical procedure used to remove the prostate gland and some of the surrounding tissue in patients diagnosed with prostate cancer. The surgery is performed using a robotic system that enhances the surgeon’s precision, dexterity, and control.

For the surgery, the patient is typically given general anaesthesia to ensure they are pain-free and comfortable during the procedure. The surgeon then begins the operation by making several small incisions (usually 5-6) in the lower abdomen to insert trocars (hollow tubes), which act as entry points for the robotic system. This system, commonly the Da Vinci surgical system, is typically equipped with specialised instruments and a high-definition 3D camera.

The robotic system is subsequently docked to the trocars, and the surgeon uses the robotic instruments to carefully dissect and remove the prostate gland, which involves precise cutting and cauterisation to minimise blood loss and ensure clean margins. When possible, the surgeon will aim to preserve the neurovascular bundles that control erectile function and continence, a process known as nerve-sparing prostatectomy.

Lastly, the bladder neck is reconstructed and reattached to the urethra. The incisions are closed with sutures or surgical glue, and a catheter is usually inserted into the bladder through the urethra to assist with urine drainage during the initial recovery phase.

How long does the surgery take?

The entire robotic radical prostatectomy procedure takes between 2 to 4 hours, depending on the complexity of the case and the patient’s specific anatomy.

What is the typical recovery time after a robotic radical prostatectomy?

Recovery time following a robotic radical prostatectomy is generally shorter compared to traditional open surgery. Most patients remain in the hospital for 1 to 2 days, and a catheter is typically needed for a few weeks to facilitate urine drainage while the urethra heals.

Patients can often return to light activities within 2 to 4 weeks, with complete recovery (including a return to normal activities and work) at around 6 to 8 weeks’ time.

How does robotic radical prostatectomy improve patient outcomes in terms of cancer control, urinary function, and sexual function?

Robotic radical prostatectomy offers significant benefits:

Cancer control

Robotic radical prostatectomy offers high success rates in terms of cancer control, particularly for early-stage prostate cancer. The precision of the robotic system enables complete removal of cancerous tissues, thereby lowering the risk of cancer recurrence.

Urinary function

One of the significant benefits of robotic surgery is its ability to preserve urinary function. The robotic system’s precision helps in sparing the nerves and muscles that control urination, leading to quicker and more complete recovery of urinary continence.

Sexual function

The nerve-sparing techniques used in robotic prostatectomy play a crucial role in maintaining erectile function. While erectile dysfunction is common shortly after surgery, most patients will see improvements in erectile function within a year, especially when nerve-sparing techniques are successfully employed.

Patients considering robotic radical prostatectomy should consult with a specialised urological and robotic prostate surgeon to determine if they are suitable candidates and to discuss the potential benefits and risks specific to their condition. Understanding the intricacies of the procedure and its advantages can help patients make informed decisions about their prostate cancer treatment.