Procedure · Prostate

Robotic prostatectomy

Robotic prostatectomy is precise, nerve-sparing keyhole surgery to remove the prostate and treat prostate cancer — with smaller incisions, less pain and a faster recovery than open surgery.

What are the indications for a robotic prostatectomy?

A robotic prostatectomy may be recommended for prostate cancer confined to the prostate. The aims of surgery are to:

  • Remove the whole prostate and seminal vesicles, along with the cancer.
  • Achieve a clear margin of tissue around the tumour.
  • Bring the PSA blood level down to unrecordable levels.
  • Reduce the need for further treatment such as radiotherapy or hormones.
  • Preserve urinary continence and, where safe, the nerves that control erections.

What are the alternatives?

  • Active surveillance — Close monitoring with PSA and repeat biopsies, with treatment only if cancer progresses.
  • Focal treatment — Targeted focal energy treatment with high-intensity focused ultrasound (HIFU), cryotherapy or electroporation (IRE), available in selected centres.
  • External beam radiotherapy — A course of targeted radiation to the prostate.
  • Brachytherapy — Insertion of radioactive seeds into the prostate.
  • Open radical prostatectomy — Removal of the prostate through an abdominal incision.

What happens before surgery?

Before surgery you will be contacted by one of our highly experienced prostate cancer specialist nurses to discuss your diagnosis and requirement for surgery, and to explain the next steps. At this stage we will arrange referral to continence and andrology specialists, who will arrange to meet you in the weeks after surgery.

Approximately 2-3 weeks before surgery you will be asked to attend for a pre-operative assessment, where blood tests and an ECG are typically performed to ensure the procedure takes place with minimal risk. Most patients should continue regular medication, although certain medications should be stopped prior to surgery. Please tell the team if you take blood thinners or have any implants, a pacemaker or a history of MRSA.

On the day of surgery you should avoid eating for six hours before, and drink only clear fluids within 2 hours of the procedure. Your consent will be confirmed and an anaesthetist will discuss your anaesthetic and pain relief. You will be given a gown and compression stockings to wear shortly before your procedure, which is performed in our dedicated private robotic surgery suite, located at the Park Hospital Nottingham.

What does the procedure involve?

A robotic prostatectomy is performed through several small keyhole incisions using the da Vinci Surgical System. The technology translates the surgeon's hand movements into highly precise, tremor-free movements while providing a magnified, high-definition 3D view of the operating field.

  • Performed under general anaesthetic, with antibiotic cover.
  • Six or seven keyhole incisions are made in the lower abdomen.
  • The prostate and seminal vesicles are freed and removed, sparing the continence muscles.
  • Where it is safe, the erection nerves are preserved — Mr Walton is trained in the NeuroSAFE technique, which can allow margins to be checked during surgery.
  • Some patients require pelvic lymph node removal at the same time as prostatectomy - you will be advised if this is needed.
  • The urethra is rejoined to the bladder and a catheter is placed while it heals.
  • The operation usually takes two to three hours, typically with a one night stay.

What are the side-effects?

  • No semen produced at orgasm, making you infertile (all patients).
  • Erectile dysfunction with some penile shortening (approx. 90-95% with no nerve-sparing; 50-60% with one-sided nerve-sparing, 40-50% with two-sided nerve-sparing).
  • Mild urinary leakage needing pads, which may persist beyond a year (10-20%).
  • More severe incontinence occasionally needing further surgery (0-5%).
  • Cancer at the margin, or a rising PSA, needing further treatment (10-20%).
  • Infection, pain or hernia at any of the port-sites requiring surgical treatment (5-10%). To reduce the chances of a hernia Mr Walton removes the prostate through a small incision low down in the abdomen (Pfannenstiel).
  • Lymph fluid collection or leg swelling (lymphoedema) after lymph node removal (2-3%).

What happens after surgery?

Most patients experience some mild abdominal pain, which usually settles down quickly. You will be encouraged to move about soon after surgery and can expect to be discharged the day after your procedure. You will receive painkillers and laxatives to take home, along with blood thinners, which you will need to self-administer for 28 days. The catheter is removed after one to two weeks; do not worry if you leak a little at first, this is normal and improves with pelvic floor exercises. Most men return to light activity within a couple of weeks.

Following surgery, the prostate is examined by a specialist pathologist and the findings are reviewed at a multidisciplinary team meeting. Once this assessment is complete, you will be contacted to discuss the results. A follow-up appointment is usually arranged around eight weeks after surgery to review your recovery, explain the pathology findings in detail, and discuss the results of your post-operative PSA blood test.

British Association of Urological Surgeons

Patient information leaflet

Read the British Association of Urological Surgeons (BAUS) leaflet: Robotic-assisted radical prostatectomy (RARP).

View the BAUS leaflet
YouTube

Patient information video

Watch the European Association of Urology animated video: Robotic Assisted Radical Prostatectomy

Watch the video