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Robotic Prostatectomy

Robotic Prostatectomy

When diagnosed with prostate cancer, patients have the option of receiving curative therapy through surgery or radiotherapy. A large proportion of patients choses surgery over radiotherapy, preferring the possibility of complete removal of the cancerous organ and the certainty of receiving a definitive histological diagnosis. In fact, studies show that in patients with aggressive prostate cancer, survival is better when they undergo surgery in contrast to other therapeutic options [1].


The newest advance in prostate cancer surgery is the introduction of robotic technology to the surgical field. The robotic system was initially developed by the United States Department of Defense to be used in military battlefield applications. The system then received approval by the Food and Drug Administration (FDA) for its implementation in everyday clinical settings.

Robotic prostate cancer surgery had been implemented with great success for the last 13 years. The most important result of robotic surgery is that cancer control is better or equivalent as compared to other forms of surgery. Also, it has recently been reported that patients experience a return of sexual and urinary function sooner after robotic surgery than with other forms of surgery[2,3]. Patients greatly benefit from the minimal invasive nature of the operation, returning quickly to their daily activities with minimal to no impairment.

An experienced robotic urologic surgeon will help the patient through the process of diagnosis and treatment of prostate cancer. Once a diagnosis of localized prostate cancer is made, and robotic surgery is decided upon, the patient can prepare himself for the intervention. The length of stay in the hospital is usually of 2 days; in the first day, the patient undergoes surgery, and in the following day, the patient is free to return home. A urinary catheter will be placed during the course of surgery, and this will be removed in the fifth day after surgery, together with the sutures of the small abdominal incisions. As of the first day after the operation, the patient will be encouraged to participate in light physical activities, will have a normal diet and will be able to completely take care of his basic needs.

In the operating room, patients are securely placed onto the operating table and then undergo general anesthesia. The robot is then brought into the operating field, and positioned onto the patient.


The tiny incisions for the placement of the robotic arms are made in the lower abdomen, and are sutured with one or two stitches each in the end of the operation.


As illustrated in the image below, during radical prostatectomy, the cancerous prostate is removed, and the continuity of the outflow of urine is reconstructed, allowing normal urination through the urethra. The operation is completed in 1.5 to 2 hours.


The dexterity of the robotic instrumentation and the clarity of the 3 dimensional vision of the field allow surgeons to operate at their highest potential. A complete and detailed visualization of the prostate and it’s borders is thus feasible. The preservation of nerves controlling erectile function is possible to an unparalleled degree, and the mechanism of urinary continence is clearly identified and protected. If indicated, a complete removal of local and more distant lymph nodes may also be performed.
Robotic surgery offers many important advantages for patients in the immediate post-operative period. The need for blood transfusions is significantly lower, because the bleeding rate during surgery is much smaller. Also, due to the minimally invasive nature of robotic surgery, the need for pain medication is much smaller, with a significant proportion of patients foregoing them completely.

  • Bibliography


1. Long-Term Survival in Men With High Grade Prostate Cancer: A Comparison Between Conservative Treatment, Radiation Therapy and Radical Prostatectomy—A Propensity Scoring Approach

Ashutosh Tewarin, George Divine, Peter Chang, M. Mendel Shemtov, Matthew Milowsky, David Nanus and Mani Menon
The Journal of Urology, Volume 177, Issue 3, March 2007, Pages 911-915

2. Systematic review and meta-analysis of studies reporting potency rates after robot-assisted radical prostatectomy.

Ficarra V, Novara G, Ahlering TE, Costello A, Eastham JA, Graefen M, Guazzoni G, Menon M, Mottrie A, Patel VR, Van der Poel H, Rosen RC, Tewari AK, Wilson TG, Zattoni F, Montorsi F.
Eur Urol. 2012 Sep;62(3):418-30.

3. Systematic review and meta-analysis of studies reporting potency rates after robot-assisted radical prostatectomy.

Ficarra V, Novara G, Ahlering TE, Costello A, Eastham JA, Graefen M, Guazzoni G, Menon M, Mottrie A, Patel VR, Van der Poel H, Rosen RC, Tewari AK, Wilson TG, Zattoni F, Montorsi F.
Eur Urol. 2012 Sep;62(3):418-30.