Radical prostatectomy

Having surgery is a highly personal experience. At Sulis Hospital, your consultant will listen to your concerns and issues. Together, you will discuss all options and approaches to prostatectomy. Your consultant will answer your questions and develop a plan of care that meets your unique needs. Sulis Hospital's extensive experience and technical capabilities with prostatectomy are experienced within a reassuring, people-orientated compassionate hospital setting. 

Prostatectomy is surgery to remove part or all of the prostate gland. The prostate gland is part of the male reproductive system. It's located in the pelvis, below the bladder. It surrounds the hollow tube called the urethra that carries urine from the bladder to the outside of the body.

Prostatectomy is a common surgery for prostate cancer. It also can treat other conditions that affect the prostate. Different types of prostatectomy may be done, depending on the condition that needs treatment.

What is a Radical Prostatectomy?

A radical prostatectomy is a surgical procedure performed specifically to treat localised or early-stage prostate cancer. Unlike a simple prostatectomy, which targets the obstructive inner tissue responsible for benign enlargement, a radical prostatectomy involves the complete removal of the prostate gland, the seminal vesicles and a small margin of surrounding healthy tissue.

Depending on your pre-operative staging and scans, nearby pelvic lymph nodes may also be removed during the procedure.

Types of radical prostatectomy

• Open radical prostatectomy 
• Open radical retropubic prostatectomy
• Open radical perineal prostatectomy
• Radical laparoscopic prostatectomy
• Nerve-sparing prostatectomy
• Robotic-assisted radical laparoscopic prostatectomy.

Simple prostatectomy (partial prostatectomy)

This is surgery that removes most of the inner part of the prostate leaving the outer part intact. Simple prostatectomy is usually done to ease symptoms of a very enlarged prostate, a condition called benign prostatic hyperplasia (BHP). This surgery is most often done using a laparoscopic and robotic approach through small cuts in the lower abdomen, it's also considered a retropubic approach. 

Types of simple prostatectomy

• Laparoscopic simple prostatectomy 
• Robotic simple prostatectomy
• Open simple prostatectomy.

At the Sulis Hospital robotic hub, this procedure is carried out by consultant urological and robotic surgeons utilising the advanced da Vinci robotic system. The approach allows our specialists to separate the diseased gland from the surrounding bladder neck and delicate structures with precision accuracy.

The robotic procedure step-by-step

The surgery typically takes between two and three hours under general anaesthesia.

Precision excision: Operating through keyhole incisions across the lower abdomen, the surgeon uses the da Vinci wristed instruments to precisely dissect the prostate and seminal vesicles away from the bladder and the rectum.

Nerve Preservation: If the cancer has not encroached upon the outer margins of the gland, the surgeon uses a micro-dissection technique to gently peel away the delicate neurovascular bundles that control erections.

Bladder reconstruction: Once the prostate is safely removed, the surgeon reconstructs the urinary tract by suturing the neck of the bladder directly back to the urethra.

Drainage placement: A temporary internal pelvic drain is typically positioned to catch any post-operative fluid or minor bleeding. 

Choosing a robotic approach provides a series of clinically proven advantages over traditional open surgery:

• Optimised cancer margins: The magnified, high-definition 3D visualisation gives the surgeon a clear view of the exact tissue boundaries.
• Significantly lower blood loss: The precise control and inflated gas within the abdomen minimise intra-operative bleeding, reducing the need for blood transfusions.
• Shorter time in hospital: Most of our patients are fit to be discharged within 24 to 48 hours. Sulis Hospital also supports a progressive pathway allowing carefully selected, suitable patients to return home safely as a day-case procedure.
• Reduced pain and scarring: Because the abdominal wall muscles are not cut open, post-operative discomfort is significantly reduced, meaning less reliance on heavy pain medications and an accelerated return to light everyday activities.

What to expect during recovery

Recovery from radical prostatectomy is a gradual process that spans several months. While your wounds heal within weeks, the internal tissues take longer to fully settle.