Robotic Radical Prostatectomy

Robotic radical prostatectomy 

Robotic radical prostatectomy is keyhole surgery to remove the whole prostate to treat prostate cancer. At Sulis, it is performed by a specialist consultant robotic urological surgeon using the da Vinci X surgical system. Compared with open or standard keyhole surgery, it usually means less pain, less blood loss, better early bladder control and a faster return to normal life. Most men go home the day after surgery.

Being told you have prostate cancer is a lot to take in. Your consultant will talk you through every option, including whether surgery is the best choice for you, and build a care plan around you.

What is a robotic radical prostatectomy?

A radical prostatectomy removes the entire prostate gland and the seminal vesicles, the small glands that sit behind it. The aim is to remove cancer completely.
In the robotic approach, the surgeon works through five or six small keyholes cut in the abdomen. They sit at a console in the operating theatre and control slim robotic instruments, with a magnified 3D view inside the pelvis. 

The robot does not act on its own: every movement is made by your surgeon.

Depending on your scans and biopsy results, nearby lymph nodes may also be removed and checked for cancer spread.

Why robotic surgery?

Robotic surgery gives small cuts of keyhole surgery with even finer control than open surgery. For most men this means a faster, more comfortable recovery and better early bladder control and erections than either older approach. 

What this means for you

• Precision where it matters: the prostate sits deep in a narrow pelvis, right next to the muscle that controls your bladder and the nerves for erections. Wristed instruments and 3D magnification let your surgeon work around them with fine control.
• A better join: stitching the bladder back to the urethra is the hardest step in keyhole surgery. The robot makes precise, watertight stitching easier, which helps healing and early bladder control.
• Less bleeding: a clear, magnified view and gentle gas pressure keep blood loss low, so transfusion is rarely needed.
• Back to normal sooner: small cuts mean less pain, home the next day and a quicker return to walking, driving and work.
• Early bladder control and erection recovery.

Is it right for me?

Robotic radical prostatectomy is usually recommended for men with:

• Prostate cancer that is confined to the prostate, or has only just spread beyond it.
• Intermediate- or high-risk cancer, based on PSA, biopsy grade and MRI.
• Good general health and a life expectancy of more than 10 years.

Your case will be discussed by a specialist team (multidisciplinary team, or MDT) of urologists, oncologists, radiologists and pathologists. Other options can include active surveillance, radiotherapy or focal therapy, and your consultant will explain how each compares for you.

What happens during the operation?

1. The operation is done under general anaesthetic and usually takes two to three hours.
2. You are positioned on the operating table, tilted slightly head-down, so the bowel moves away from the pelvis.
3. Small keyhole cuts are made in the abdomen and it is gently filled with gas to create working space.
4. The prostate and seminal vesicles are freed from the bladder, rectum and surrounding tissue.
5. Where it is safe, the nerves that control erections are carefully preserved (nerve-sparing).
6. If needed, lymph nodes in the pelvis are removed.
7. The bladder is stitched back to the urethra (the water pipe), and a catheter is left in place while this join heals.
8. The prostate is removed in a bag through one of the cuts, usually slightly enlarged near the belly button, and sent for detailed analysis.

Nerve-sparing surgery

Two thin bundles of nerves run alongside the prostate and are needed for erections. If the cancer is not close to them, your surgeon will try to preserve one or both. Whether this is possible depends on your MRI and biopsy results, and your consultant will discuss it with you before surgery. 

Preparing for surgery

• Pre-operative assessment: checks of your general health, blood tests and an ECG if needed.
• Pelvic floor exercises: start these before surgery using the Squeezy app.
• Medicines: tell us if you take blood thinners, as these may need to be stopped.
• Fitness: staying active and stopping smoking before surgery help your recovery.

Your hospital stay

Most men stay one night. You will be up and walking within hours, eating and drinking normally, and you will go home with a catheter and a leg bag. Our nurses will show you how to look after it before you leave.

Recovery at home

Catheter: usually stays in for 7 to 10 days and is removed in clinic.
Activity: walk daily. Avoid heavy lifting and strenuous exercise for about six weeks.
Driving: usually after two to four weeks, once you can make an emergency stop comfortably.
Work: desk-based work after about two to four weeks; manual work after about six weeks.

Results and follow-up

The prostate is examined in detail by a pathologist and your consultant will discuss the results with you, usually two to three weeks after surgery. Your PSA blood test is checked about six weeks after the operation and then regularly. After successful surgery, PSA should fall to an undetectable level.