What is Robotic Prostatectomy?

Robotic prostatectomy is a robot-assisted laparoscopic radical prostatectomy. A radical prostatectomy is the complete removal of the prostate gland as well as some of the surrounding tissue. This surgery is performed to eradicate prostate cancer, a disease in which the cells of the prostate in the male reproductive system mutate and multiply uncontrollably. Laparoscopy, in which the doctor inflates the abdomen and inserts a lighted viewing instrument into the lower abdomen, allows doctors to see inside the patient without making large incisions like in an open surgery. Using laparoscopy, a doctor may be able to avoid open surgery entirely, which can decrease the risks, recovery period, and scarring involved with a more invasive surgery.

If the cancer is in stage I or stage II, meaning it has not progressed outside the prostate, a radical prostatectomy is generally effective at preventing the development of advanced cancer. The retropubic approach, an open prostatectomy performed through the belly, is the standard procedure for prostate removal. The perineal approach, an open surgery through the groin, has a shorter recovery period, but is less effective if lymph nodes must also be removed. Laparoscopic and robot-assisted prostatectomy are newer and seem to be as effective at removing the cancer, while causing less bleeding and shorter recovery times. There is argument as to whether robotic prostatectomy decreases the long term side effects of incontinence and erectile dysfunction, or not.

A robotic prostatectomy is similar to a laparoscopic prostatectomy, but performed with robotic arms instead of by a surgeon’s hands. Laparoscopic surgery is done through several small abdominal incisions. The laparascope, or viewing instrument, is inserted through one incision and specialized instruments to remove the prostate are inserted through the other incisions.

In a robotic prostatectomy, a specially trained doctor controls the robot’s arms so that the surgeon’s incisions are translated to more delicate and precise movements. A surgeon seated a few feet from the operating table controls the robot arms with a joystick and foot pedals. The three robotic arms, one which controls the viewing device and two which control the surgical instruments, can rotate 170 degrees, flex, grip, and release.

Robot-assisted surgeries are more expensive for the patient and the hospital, which must invest in the special doctor’s training and equipment for the treatment. Patients, however, can hope for several potential benefits from a robotic prostatectomy over the standard procedure. Institutions report lower incidence of complications, less loss of blood, less pain, shorter catheterization period, and less scarring. The procedure should only be performed by doctors specially trained to conduct a robotic prostatectomy, otherwise a laparoscopic or standard procedure is preferable.