Robot Assisted Radical Prostatectomy

written by Dr Thomas Dean MBBS (UNSW), FRCS (Edin) FRACS (Urol)

This is now an established and appropriate treatment option for most men who require surgery for their prostate cancer. The procedure is performed by keyhole surgery using a number of small incisions instead of the single larger incision used in radical retropubic prostatectomy.

The surgery is performed with the Da Vinci robot system. Under a full anaesthetic the patient is placed in the head down position so that the bowel moves away from the prostate and the pelvis into the upper abdomen out of harm’s way. The abdominal cavity is then inflated with gas to facilitate the insertion of small tubes (called ports) through the abdominal wall. The camera and instruments are then inserted and connected to the robotic arms. The surgeon sits comfortably at a console in the operating room and controls the camera and instruments. An assistant surgeon works at the operating table.

Advantages include reduced bleeding due to the pressure from gas inflation of the abdominal cavity, excellent 3D visualisation and magnification, and easier suturing with the robotic instruments that helps greatly when joining the urethra (water pipe) to the bladder after the prostate has been removed.

Definite clinical advantages include reduced blood loss, reduced hospital stay, earlier return to normal activities, and a more secure anastomosis (join up) between the urethra and bladder. It is hoped that due to the excellent vision there may be better cancer control, and improved urinary control and erections although there is still some debate on this issue.

Any surgical or invasive procedure carries risks. The information provided here is for general educational purposes only. Please contact Dr Thomas Dean to find out if robot assisted radical prostatectomy is appropriate for your individual situation.