Robotic prostatectomy surgery (da Vinci prostatectomy)

Robotic prostatectomy, also known as the da Vinci prostatectomy, is the treatment of choice in the US. It is minimally invasive and working within a highly magnified field, the surgeon is able to optimally perform nerve-sparing surgery, reducing the risk of incontinence and impotence.

This new technology, called the da Vinci surgical robot, was first introduced in 1999 and there are now more than 300 robots in use worldwide. Our consultant urologist Marc Laniado was part of one of the first teams in the UK to start using the da Vinci robot during the early phase. Read accounts from our patients who have been treated using robot-assisted prostate surgery

It is important to emphasise that a robotic prostatectomy is not carried out by a robot. A more accurate description would be computer-assisted surgery, with the surgeon working with the robot in the operating theatre.

How does it work?

The robot is made up of two units. The first unit is on the patient side, there are four robotic arms. One arm holds a high magnification camera and the other three hold instruments. The surgeon sits at the second unit, which is a console with a three-dimensional view of the operating field, that provides a very high definition image in three dimensions with accurate perception of depth. The view is very stable and makes it easy for the surgeon to see and perform the procedure.

Like a laparoscopic prostatectomy, the operation takes place through six small incisions, known as ports, which are 0.5 to 2cm wide. Four robotic arms, which are about 7mm wide, are inserted through fou of these ports, and the other two ports are used by an assistant.

The hand movements of the surgeon are translated in real time movements by the robotic arms. The system is designed to remove any hand tremor and ensure very precise movements, achieving truly computer-assisted surgery.

What are the advantages of a robotic prostatectomy?

The incisions made during a robotic prostatectomy are much smaller than those used for an open prostatectomy (10–15cm). This means patients experience a much shorter recovery time, less scarring and reduced pain following robotic surgery compared with an open operation. Recovery time after a robotic prostatectomy is very similar to recovery time after a laparoscopic prostatectomy, with a typical hospital stay of two days and a return to normal activities within weeks.

There is extensive evidence to show that for early, organ-confined prostate cancer, da Vinci prostatectomy is as effective in terms of removing all cancer cells as open surgery.

The highly-magnified view in three dimensions of the nerves and blood vessels surrounding the prostate makes it much easier to avoid damaging the nerves responsible for continence and erectile function. This is much more difficult in open prostatectomy performed without magnification resulting in the loss of erectile nerves and reduced continence after surgery.

The da Vinci prostatectomy has become increasingly popular for several reasons. In robotic surgery, the view is in three dimensions as in open surgery; but unlike open surgery, the view is magnified 10 to 15 fold. The 3D vision helps the surgeon to perform accurate surgery, which is more difficult in laporoscopic surgery which views in two dimensions. Furthermore, the instruments used in robot-assisted surgery have more natural movements, that are comparable to the human hand. They are said to be 'wristed', in contrast to the instruments used for laporoscopic surgery which have a limited range of movement.

There is no clear evidence about how robotic prostatectomy and laparoscopic prostatectomy compare in terms of nerve damage. Both certainly reduce damage and can achieve very good results. A difficulty is the fact that surgeons measure their results in different ways making it hard to accurately compare.

Harley Street Urology has developed an index of patients who choose nerve-sparing surgery, have full erectile function before surgery and are motivated to achieve erectile function after surgery with our support.

What are the disadvantages of a robotic prostatectomy?

There is no tactile feedback unlike open or laparoscopic prostatectomy, and so the surgeon needs to use visual cues more. However, the surgeon can see a highly-magnified view in high definition and in three dimensions. This more than compensates for the loss of feedback and allows excellent results to be achieved.

How do I choose which type of surgery is right for me?

If there is a concern that cancer has spread beyond your prostate, your surgeon may recommend an open prostatectomy as the safest way of treating you. If you have organ-confined, early prostate cancer, our specialists will provide you with all the information and advice you need to choose the right type of surgery for you. Many private hospitals offer either robotic prostatectomy or laparoscopic prostatectomy. We offer both and can therefore provide you will an informative view and evidence of the robotic and laparoscopic options.

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Read accounts from our patients who have been treated using robot-assisted prostate surgery