Robotic-assisted radical prostatectomy

Prostate cancer is the most common cancer in men. Radical prostatectomy is a surgical procedure that removes the prostate gland in order to treat the cancer.

Traditional open surgery involves a large incision in the abdomen or perineum, which can cause significant discomfort and a longer recovery time. Robotic-assisted radical prostatectomy is a minimally invasive approach that uses a robotic device controlled by the surgeon to perform the surgery.

Before the surgery:

Before the surgery, Dr Sethi will perform a thorough evaluation of your medical history, physical exam and conduct diagnostic tests such as an MRI, biopsy or PSMA PET scan.

You may need to stop taking certain medications, such as blood thinners, before the surgery. You will need to complete a preoperative blood and urine test and also see a continence physiotherapist to commence pelvic floor (Kegel) exercises.

Technique:

During the procedure, the surgeon controls the robot using a console in the operating room and has an assistant surgeon working with him. There are usually six keyhole incisions in the abdomen allowing surgical instruments including four robotic arms and a camera into a magnified, 3D view of the surgical field. The robot’s precision and manoeuvrability allow for greater accuracy and control during the surgery.

The prostate and seminal vesicles are separated from surrounding structures and the surrounding lymph nodes may also need to be removed. The nerves to the penis that allow erections lie very close to the prostate and a nerve-sparing approach is usually performed if the cancer doesn’t come too close or grow into the nerves. The bladder is re-joined to the urethra (water pipe) and a catheter drains urine until the join heals (7 to 10 days).

After the surgery:

After the surgery, you will remain in hospital for 1-2 nights where you will be monitored closely. Your catheter will drain urine into a bag which is secured to your leg and can be concealed under your trousers, with a larger overnight bag when asleep.

We will ensure you are confident in caring for your catheter prior to discharge. You will need to rest for a few days after the surgery, but you should begin walking and doing light activities as soon as possible to prevent blood clots and promote healing.

Our nurse will remove the catheter in our clinic, which is a quick and relatively painless procedure. You will usually find it comfortable to return to driving once the catheter has been removed. Depending on your job, you can usually return to work around 3-4 weeks after the operation but won’t be able to do vigorous exercise or heavy lifting for 6 weeks after the operation.

Sexual function:

Robotic-assisted radical prostatectomy can affect sexual function, including erections and ejaculation. Most men experience some degree of erectile dysfunction after the surgery (even with a nerve-sparing approach), which may improve over time.

We will discuss a penile rehabilitation programme involving medications at your postoperative review appointment to help return erectile function. You may require the use of medication, injections or vacuum devices on an ongoing basis.

After the operation, you will no longer produce semen and will be infertile. You may notice that your penis is shorter after the operation. This is usually up to 1cm and studies show that the length usually returns to normal at around 12 months.

Continence:

Robotic-assisted radical prostatectomy affects urinary continence, or the ability to control urine. All men will experience some degree of urinary incontinence after the surgery, which improves for the majority over time.

Regular pelvic floor exercises will help strengthen your pelvic floor muscles and improve urinary control. A small group of men (<5%) may experience long-term urine leakage requiring long-term continence pads or further surgery.

Further treatment

After the surgery, Dr Sethi will monitor your cancer status through periodic PSA (prostate-specific antigen) blood tests over several years. PSA is a protein produced by the prostate gland that can be measured in the blood. Most prostate cancer is confined to the prostate so removal is usually curative.

PSA levels after curative surgery are expected to be undetectable. If there is a PSA level rise, it may be a sign that prostate cancer has recurred. In this scenario, Dr Sethi will discuss the need for further scans and possible treatments such as radiotherapy or medications.