What Is Robotic Prostate Cancer Surgery, What Are Its Advantages?

Robotic prostate cancer surgery is a minimally invasive procedure performed through a few small incisions in the abdomen, aiming to remove the prostate. The surgeon uses the da Vinci robotic system to operate under 3D magnified vision, making precise, tremor-filtered, millimetric movements to remove the prostate. This system translates the surgeon’s hand movements into steady, highly precise maneuvers, providing enhanced accuracy and control.

What Is Robotic Prostate Cancer Surgery?

Robotic prostate cancer surgery, medically known as robotic radical prostatectomy (RARP), is a closed (minimally invasive), robot-assisted surgical method in which cancerous tissue in the prostate gland is removed through small incisions. The operation is performed using the da Vinci robotic surgical system, which is controlled by the surgeon from a console. 

Although the term “robot” may suggest a device that performs surgery on its own, the situation here is different: This system is not autonomous. In other words, the surgeon conducts every moment of the operation. Surgeon uses the da Vinci robotic surgical system while seated at the console. System turns hand movements of the surgeon to 3 dimensional, tremor-filtered, millimetric maneuvers. This allows the use of fine instruments that can articulate like a wrist even in narrow spaces.

The goal of robotic prostate cancer surgery is the safe removal of the prostate gland. When necessary, depending on the extent of the disease, nearby lymph nodes can also be removed using the same closed technique. The clear view and precise maneuverability offered by the robotic system help the surgeon better identify the nerves and blood vessels surrounding the prostate. This helps prevent damage to surrounding tissues while removing the cancer.

The difference between robotic surgery and traditional open surgery lies not so much in how it is performed but in how it is visualized and controlled. High-resolution 3D imaging, depth perception and wrist-like instrument articulation provide the surgeon with a high level of precision. For this reason, it has become a modern method that is frequently used in the treatment of prostate cancer today.

How Is Robotic Prostate Cancer Surgery Performed?

Robotic prostate cancer surgery is a closed surgery performed under general anesthesia. Usually, 5-6 small incisions are made in the patient’s abdominal area, through which a camera and thin surgical arms that mimic wrist movements are inserted. After CO₂ gas is introduced into the abdomen, the robotic system is locked to the ports on the operating table, and the surgeon, seated at the console, transfers hand movements to the robot. 

Before removing the tumor, the surgeon checks the safety of the tissues and blood vessels in front of the prostate. If the tumor’s location and stage are suitable, the nerves that are crucial for erections are protected from heat and trauma. This procedure is called nerve-sparing surgery.

Next, the procedure reaches the apex of the prostate where it connects to the urethra. Here, the urethra is carefully divided and the prostate is separated. The removed cancerous tissue is placed in a special bag (endobag) and taken out of the abdomen. In some patients, the pelvic lymph nodes can also be removed during the same session and sent to pathology department.

After the surgery, a urinary catheter is placed to manage urine control. All technical steps are personalized by the surgeon according to the patient’s tumor characteristics and anatomy.

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Who Can Undergo Robotic Prostate Cancer Surgery?

Robotic prostate surgery is generally performed on patients whose cancer is confined to the prostate and has not metastasized. Although active monitoring is usually the first choice for low-risk cancer, surgery may be performed in younger patients, people that are not suitable for monitoring or those who prefer active treatment.

In intermediate and high-risk prostate cancers that have not metastasized, robotic surgery is performed and pelvic lymph node removal is done if deemed necessary. Urologists assess this using tests such as PSA, MRI and biopsy. Patient’s general condition should be good for this operation.

If the cancer has spread (to the bones, lymph nodes, etc.), if the patient has severe heart-lung problems, conditions that prevent tolerance of the anesthesia position or active infection/bleeding tendencies, surgery may not be considered appropriate. In such cases, other options like medication or radiation therapy stand out.

What Should You Pay Attention To After Robotic Prostate Surgery?

The recovery process after robotic prostate surgery depends on the individual but there are certain key aspects that require attention. These aspects are:

• Patient should not lift heavy for the first 4-6 weeks.
• The incisions should remain dry and clean and wound care should be performed regularly.
• Plenty of water and fiber-rich foods should be consumed and constipation should be avoided.
• In the first weeks, tea, coffee, carbonated drinks, spicy foods and alcohol can irritate the bladder and should be avoided if possible.
• Pelvic floor (Kegel) exercises, as prescribed by the doctor, should be performed regularly.
• Patient can return to desk work usually within 1-2 weeks, while physically demanding jobs may require 4-6 weeks before returning. This period is determined by the doctor according to the patient’s condition.
• Sexual activity is paused during the first weeks; recovery of erections takes time. If the doctor deems it necessary, medications or supportive therapies may be planned.
• Prescribed antibiotics, pain relievers and (if given) blood thinners should be taken on time. 

If there are:

• 38 °C and over fever, chills-shivering,
• No urine in the bag or blockage due to large clots,
• Increasing abdominal-lower abdominal pain, unbearable pain,
• Rapidly increasing redness, swelling, foul-smelling discharge at incision place,
• Unilateral swelling-pain in thigh,
• Chest pain, shortness of breath symptoms, patient should apply to hospital as soon as possible.

What Are Advantages Of Robotic Prostate Cancer Surgery?

Since robotic prostate surgery is performed closed, it has many advantages over open surgery. In this method, the surgeon can perform millimetric movements using a three-dimensional, magnified view. This allows for clearer visualization of the surgical field and more precise work in confined spaces. This helps protect the nerves, blood vessels and structures responsible for urinary continence.

The main advantages of robotic prostate surgery are:

• Since smaller incisions are made, scars on the skin are smaller.
• Since there is less bleeding, there is less need for blood infusion.
• Pain is felt less.
• Hospitalization duration is less.
• Patient can return to daily life and work faster.
• 3D magnified and clearer view is provided for the surgeon.
• Allows for the preservation of nerves.
• There is less complication risk.
• Allows for shorter catheter time and better comfort.
• Erectile function can recover better in the early period.
• Early recovery of urinary continence may be possible.

Frequently Asked Questions About Robotic Prostate Cancer Surgery

How Long Does Robotic Prostate Cancer Surgery Take?

The operation usually takes 3-4 hours. However, operation time varies depending on patient’s anatomy, the extent of tumor and additional procedures (such as lymph node removal).

When Is The Catheter Removed After Robotic Prostate Surgery?

Urinary catheter is removed 5-10 days after the surgery in most patients; it is generally removed at day 7. If the condition of surgery connection (bladder-urethra) is suspicious, your doctor can extend it to 10-14 days. In some cases, x-ray/leakage test is performed to check it before removing the catheter.

How Long Does Urinary Incontinence Last After Robotic Prostate Surgery?

In the early period after surgery, leakage or dribbling is common. In most patients, significant improvement begins within the first 6-12 weeks; within 3-6 months, the majority either reduce or stop using pads.