Prostate Cancer Surgery: Robotic vs. Open
- Prostate cancer surgery is a highly effective treatment for many men with localized disease. The goal is to remove the prostate gland and surrounding tissues (such as seminal vesicles) to eliminate cancer. This procedure is called a radical prostatectomy.
- It can be performed using two primary approaches: open radical prostatectomy or minimally invasive (robot-assisted laparoscopic) prostatectomy.
- While both robotic and open prostatectomy can offer excellent cancer control, robotic-assisted surgery has emerged as the preferred method for its potential advantages in recovery time, pain, and preservation of function.
- Benefits of robotic surgery can include less blood loss during the operation, less postoperative pain, faster healing time, and shorter hospital stay (1-2 days vs. 2-4 for open surgery).
“The robot has really revolutionized our ability to operate in that small space, to be able to apply fine dissection, tremor, less movements of the hands to dissect these nerves off of the prostate, and at the same time, suture the bladder back to the urethra after the prostate is removed,” Dr. Randall Lee, a urologist at Fox Chase Cancer Center in Philadelphia, tells SurvivorNet.
Read MoreHow Is Prostate Cancer Surgery Performed?
The goal of prostate cancer surgery is to remove the prostate gland and surrounding tissues (such as seminal vesicles) to eliminate cancer. This procedure is called a radical prostatectomy.It can be performed using two primary approaches:
- Open radical prostatectomy, where the surgeon makes one large incision to access the prostate
- Minimally invasive (robot-assisted laparoscopic) prostatectomy, where small incisions and robotic instruments are used for the same purpose
Regardless of the technique, the surgery also involves cutting and rejoining the urethra and bladder neck. In some cases, nearby lymph nodes are removed for cancer staging. Nerve-sparing techniques may be used if possible, to preserve erectile function.
What Is A Robotic Prostatectomy?
A robotic-assisted laparoscopic prostatectomy (RALP) is a minimally invasive procedure that uses a robotic surgical system, such as the da Vinci® Surgical System. The surgeon operates from a console, controlling robotic arms that hold surgical instruments and a high-definition 3D camera.
Tiny incisions (usually 5-6) are made in the lower abdomen to insert the instruments. The robotic system translates the surgeon’s hand movements into precise actions inside the patient’s body. The camera provides magnified views that help in identifying nerves and structures crucial to continence (bladder and bowel control) and sexual function.
This technique has become the most common method for prostate removal in the United States and other parts of the world, primarily due to its precision and potentially quicker recovery times.
Robotic Surgery Vs. Open Prostatectomy
Open radical prostatectomy involves making a single large incision — typically from the navel to the pubic bone (retropubic approach). The surgeon manually removes the prostate and nearby tissues. While this method is highly effective, especially in the hands of experienced surgeons, it is generally more invasive than robotic surgery.
Robotic-assisted prostatectomy and open prostatectomy both aim to achieve the same surgical outcome — complete removal of the prostate and nearby tissue affected by cancer — but the techniques differ significantly in execution and recovery. Robotic surgery is minimally invasive and involves making several small incisions in the abdomen to insert a camera and specialized robotic instruments.
This method allows the surgeon to operate with a magnified 3D view and a high level of precision. In contrast, an open prostatectomy involves a single, larger incision — typically running from just below the navel to the pubic bone — to provide direct access to the prostate.
Because of the smaller incisions, patients who undergo robotic surgery typically experience several benefits, including:
- Less blood loss during the operation
- Less postoperative pain
- Faster healing time
- Shorter hospital stay (1-2 days vs. 2-4 for open surgery)
Recovery at home also tends to be quicker after robotic surgery, with many patients resuming light activity within two to four weeks, whereas open surgery may require four to six weeks or more for full recovery. From a cosmetic standpoint, robotic surgery results in minimal scarring due to the small incision size, while open surgery leaves a more noticeable scar.
The robotic approach also provides improved visualization, which can enhance the surgeon’s ability to spare the delicate nerves responsible for urinary continence and erectile function. However, it’s important to note that outcomes ultimately depend more on the surgeon’s experience and skill than on the specific technique used.
Robotic surgery may also result in quicker return of urinary continence and sexual function, though individual results can vary.
How Do The Side Effects Differ?
Both surgeries carry the same general risks, including bleeding, infection, and complications related to anesthesia. However, functional outcomes, particularly urinary continence and erectile function, are of major concern for most patients.
Most men experience some degree of incontinence initially. Robotic surgery may lead to a quicker return to continence due to better precision in preserving structures around the urethra. Long-term incontinence rates are similar between both methods with experienced surgeons.
Nerve-sparing techniques can help preserve erectile function in eligible patients. Robotic surgery may offer a better chance at nerve preservation, though outcomes depend largely on the patient’s preoperative function and cancer location. Full recovery of sexual function can take months or more than a year.
Some men may also experience lymphedema (swelling due to lymph node removal), hernias, or bowel issues. Robotic surgery typically results in fewer wound complications due to smaller incisions.
How Long Does Each Surgery Take?
Robotic prostatectomy generally takes 2.5 to 4 hours, depending on anatomy and surgical complexity.
Open prostatectomy often takes 2 to 3 hours, though actual time may vary.
Robotic surgery may take longer due to setup and docking of the robotic system, but the benefit is often a more meticulous and nerve-sparing operation.
How Long Will I Be In The Hospital?
Hospital stay is significantly shorter with robotic surgery, with most patients going home within 24 to 48 hours.
With open prostatectomy, patients typically remain in the hospital for 2 to 4 days, depending on healing and complication risks.
Both methods usually require a urinary catheter for 7 to 10 days after surgery to allow the urethra-bladder connection to heal.
Am I A Candidate For Prostate Cancer Surgery?
Most men with localized prostate cancer are eligible for robotic surgery. It is particularly suited for patients with fewer comorbidities, as they can benefit from a faster recovery.
It’s ideal for those who desire reduced downtime and minimal scarring — and younger men may be more interested in the nerve-sparing techniques.
Open prostatectomy is suitable for men who can’t undergo laparoscopic procedures due to prior abdominal surgeries, obesity, or other anatomical challenges.
It may be preferred by surgeons more experienced in the open technique and is often recommended if the cancer is locally advanced and may require wider excision.
Regardless of the approach, surgeon experience plays a critical role in outcomes. An experienced open surgeon may achieve equal or better results than a less experienced robotic surgeon, and vice versa.
Questions To Ask Your Doctor
- Am I a candidate for prostate cancer surgery?
- Why do you recommend robotic surgery over open, or vice versa?
- What is your experience performing prostate cancer surgery?
- How will we deal with side effects?
- Can we make a recovery plan?
Content independently created by SurvivorNet with support from Novartis Pharmaceuticals Corp.
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