Robotic prostatectomy, a step further compared to the open one (why it’s more advanced)

The prostate is a gland located below the bladder and in front of the rectum in men. It plays an important role in the production of seminal fluid that nourishes and transports sperm.

There are several diseases that can affect the prostate, including prostate cancer. When they occur, a prostatectomy or even a robotic prostatectomy may be essential or even life saving.

Let’s see what is a robotic prostatectomy, what are its differences compared to a regular one and what are its benefits.

What is a robotic prostatectomy

Robotic assisted prostatectomy, or robotic-assisted radical prostatectomy (RARP), is a minimally invasive surgical procedure for the treatment of many prostate conditions. It involves the use of a robotic surgical system, such as the Da Vinci robotic surgical system, to assist the surgeon in performing a radical prostatectomy, which is the removal of the entire prostate gland and surrounding tissues.

Prostatectomy robotic steps

The robotic prostatectomy is performed using a robotic surgical system: the surgeon sits at a console and controls robotic arms equipped with specialized instruments, which are inserted into the patient through small incisions in the abdomen.

The robotic system thus provides a magnified 3D rendition of the operating field, allowing for enhanced precision.

The robotic system allows the surgeon to move with increased dexterity and maneuverability, allowing for precise movements in the pelvic region. The Da Vinci robot is capable of mimicking the surgeon’s movements with great precision.

The steps in detail

There are 10 fundamental steps that define a robotic prostatectomy. These are:

Patient Preparation. During this step anesthesia is administered to the patient, ensuring they’re unconscious and pain-free during the surgery.
Trocar placement. Small incisions (trocars) are made in the patient’s abdominal wall.
Robot docking. The robotic surgical systems gets docked over the patient, and the surgeon starts controlling the instruments from the console
Insertion of instruments. The surgeon inserts the robotic arms with the instruments through the trocars.
Creation of pneumoperitoneum. Carbon dioxide gas gets pumped into the abdominal cavity to create a pneumoperitoneum.
Visualization. The 3D camera provides high-definition images of the prostate, allowing the surgeon to perform more precise movements.
Dissection of prostate and surrounding tissues. The prostate gets dissected and carefully removed. The surrounding tissues may also be removed to ensure the complete elimination of cancerous cells.
Suturing and closure. Once the prostate is removed, the surgeon sutures the remaining structures, and any necessary reconstruction is performed.
Removal of instruments and trocars. The robotic instruments are withdrawn and the trocars are closed with stitches or surgical tape.
Recovery. The patient is moved to the recovery room, where they are monitored as they wake up from anesthesia. Further monitoring may be necessary.

Prostatectomy robotic anesthesia

In order to perform a robotic prostatectomy, the surgeon has to administrate anesthesia to the patient to ensure that they’re unconscious and not experience any kind of pain or discomfort during the surgery. There are two different types of anesthesia used for robotic prostatectomy:

General anesthesia. It’s the most popular and commonly used of the two. It involves the administration of medications through an intravenous line to introduce a deep state of unconsciousness. Once the patient is unconscious, a breathing tube gets inserted into the trachea to facilitate controlled breathing. During this procedure, the patient’s vitals signs (heart rate, blood pressure, oxygen levels) are closely monitored by the surgeon or the anesthesia team.
Regional or spinal anesthesia. In this case the medication is injected into the patient’s epidural space of the spine, causing temporary numbness from the waist down. This method allows the patient to be awake during the surgery while feeling no pain.

Prostatectomy robotic recovery

The recovery time after a robotic prostatectomy can vary from person to person and depends on several factors, including the individual’s overall health, the extent of the surgery, and how well the patient follows postoperative care instructions.

Usually, Most patients who undergo robotic prostatectomy can expect to spend one to two days in the hospital. However, some patients may be discharged on the same day or, in certain cases, may stay longer depending on their recovery progress.

When it comes to the restrictions, Patients are typically advised to avoid heavy lifting and practice intense physical activities for several weeks following surgery. Sexual activity may also be restricted for a few weeks or a couple of months. Follow-up appointments with the doctor are usually scheduled to monitor recovery.

While the robotic prostatectomy offers several advantages, it may not be suitable for every patient. Let’s see the differences between the robotic prostatectomy and a regular one.

The open prostatectomy and the robotic prostatectomy comparison

The regular (open) prostatectomy and the robotic one differ in many ways, each with their own advantages and disadvantages, although they are basically used to treat the same conditions.

The choice between open prostatectomy and robotic prostatectomy usually depends on several factors, including the patient’s health, the prostate’s size and the cancer’s stage.

The main difference between them lies in the surgical approach and in the techniques used to remove the prostate or parts of it. So is robotic surgery better for prostate removal?

Advantages of both approaches

With the open prostatectomy the surgeon:

Makes a single large incision in the patient’s lower abdomen to gain access and remove the prostate.
Directly visualizes the surgical field and performs the operation with traditional instruments

The main advantages of the open approach are:

direct tactile feedback (the surgeon feels the prostate directly with their hands, which can be beneficial).
In cases where the prostate is significantly enlarged, an open approach may provide the surgeon with better access and control.
Lower risks of bladder neck contracture.
No risks of abdominal complications.

On the other hand, with the robotic prostatectomy, the surgeon:

uses a robotic surgical system to make smaller incisions and insert special instruments.
The robotic system provides enhanced precision and flexibility.

The main advantages of the robotic approach are:

It’s a minimally invasive procedure, as it involves smaller incisions.
Very low risk of messing up from the surgeon, as the robotic system doesn’t shake during operations.
Less blood loss.
Shorter recovery times.

The robotic prostatectomy is seen as a way superior approach.

The Retzius sparing prostatectomy (RRP)

The Retzius sparing prostatectomy (RRP) is a type of robotic prostatectomy used to remove the prostate gland while sparing the Retzius space. This space is located between the prostate gland and the bladder. It is usually used to reduce urinary incontinence and erectile dysfunction, which are common side effects to the robotic prostatectomy, which we’ll cover later on.

Life expectancy after a robotic prostatectomy

The patient’s life expectancy after a robotic prostatectomy depends on many factors. The main one is definitely the cancer’s stage at the time of diagnosis. If the cancer is localized in the prostate, and thus removable through the prostatectomy, life expectancies are higher. However, if the cancer has spread in other parts of the body, it might be lower.

The patient’s age is also an important factor. Younger, healthier patients have a more positive prognosis.

The long term effects of a robotic prostatectomy

People who undergo a robotic prostatectomy can experience long term effects after the surgical operations. These long term effects depend on the patient’s overall health, the extent of the cancer, and the success of the surgery. Among these affects, the most common ones are:

Urinary incontinence, which gradually and naturally improves later on.

Temporary erectile dysfunction.

Long term erectile dysfunction, which especially affects the elderly.

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