Robotic Surgery For Prostate Cancer
- For patients who need to undergo prostate cancer surgery, to remove the prostate gland, robotically-assisted surgery offers a more precise approach and better recovery time than open surgery, which was utilized more often in the past.
- Robotic prostate surgery, also called robot-assisted radical prostatectomy, uses small instruments controlled by a surgeon from a robotic console.
- This surgical approach helps patients “with a quicker recovery, less blood loss, much improved pain scores,” Dr. Akshay Bhandari, director of robotic surgery at Mount Sinai Medical Center in Miami, tells SurvivorNet.
- Typically, these patients are discharged from the hospital the day after surgery.
Dr. Akshay Bhandari, director of robotic surgery at Mount Sinai Medical Center in Miami, tells SurvivorNet that these days, it’s rare for prostate cancer patients to undergo open surgery. Robotically-assisted surgery offers a more precise approach and better recovery time.
Read MoreWhat Is Robotic Prostate Surgery?
Though surgery to remove the prostate gland can be done via open surgery, a minimally-invasive laparoscopic or robotic approach is often utilized. In open surgery, the operation is conducted through a larger incision, whereas minimally invasive surgery is done with specialized instruments through multiple smaller incisions.Robotic prostate surgery, also called robot-assisted radical prostatectomy, uses small instruments controlled by a surgeon from a robotic console. Despite the name, there’s no autonomous robot — it’s your surgeon’s hands at work, just with more dexterity and control.
The robot allows surgeons to operate through small keyhole incisions with a 3D camera that magnifies the field 10 times. That precision is especially important when operating near delicate structures like the nerves responsible for erections and continence.
Robotic surgery helps patients “with a quicker recovery, less blood loss, much improved pain scores,” Dr. Bhandari explains. “Patients are usually able to go home the day or the next day after surgery.”
Am I A Candidate?
Not everyone with prostate cancer needs surgery. But for those who do, typically men with localized disease, robotic surgery is often preferred over traditional open surgery.
You might be eligible if:
- Your cancer is confined to the prostate (stages I and II)
- You are healthy enough to undergo surgery (e.g., you don’t have severe heart failure or recent stroke)
- You want a definitive treatment with curative intent
What To Expect Before & After Surgery
Once surgery is scheduled, you’ll go through a preoperative workup, including blood tests, imaging, and possibly a urology nurse education session.
Some things your doctor might recommend include:
- Stopping certain medications (like blood thinners) a week before
- Fasting for around 6 to 8 hours
- Planning for someone to drive you home after surgery
Don’t hesitate to ask about logistics like catheters, recovery time, or sexual function — nothing should be off-limits with your medical team.
Many patients who undergo prostate cancer stay in the hospital overnight, and are discharged the next day.
“Typically the patients who are undergoing robotic surgery for prostate cancer come to the hospital the day of the operation. They typically come in about an hour or two before. Get them an IV, have them talk to anesthesia, just the usual preparation that any surgical procedure would take,” Dr. Bhandari explains.
“The surgery itself, in most experienced hands, is about an hour and a half to two. This involves removing the entire prostate, removing the lymph nodes in most instances. You’re usually recovering in the recovery room for about an hour or two. Once you’re awake enough, you’re transferred to the usual floor where you’re there overnight and are discharged home.”
The next day, patients are able to go home, typically with a catheter in place, he adds.
“After we remove the prostate, we have to put the bladder back together with the urethra so you can pee and this is done with the help of sutures,” Dr. Bhandari explains. “In order for it to heal, we leave a catheter in. Which is essentially a tube that is letting the urine flow while the healing happens.”
Typically, the catheter is left in place for about a week.
The Recovery Timeline
In the first few days after surgery, men can expect to experience mild discomfort, bloating, or gas pain. You’ll likely walk around the hospital room the same day of the surgery. You will go home with a catheter, which usually stays in for about 5-10 days.
Within two weeks of surgery, the catheter should be removed and you can resume light activity. Doctors typically recommend avoiding lifting anything over 10 pounds. However, light movement and walking about is encouraged. Those who work in offices may be able to return to work within four or so weeks of surgery.
“After the catheter comes out, some people may experience mild to moderate incontinence, where they’re not able to control the urine that comes out because they’ve lost one of the two muscles that control urination in men,” Dr. Bhandari explains.
“Sometimes it may take a while for that other muscle to make up the function of the lost muscle. Typically we tell people that it may take up to six weeks before you start seeing improvement, and typically most people should recover their control between three to six months.”
Within three months, side effects, like erectile function, may begin to return. PSA (prostate-specific antigen) levels will be checked in the blood to ensure cancer progress is not detected. How long side effects last varies from case to case.
“The nerves that supply the penis that cause erections run very close to the prostate. So when we do the surgery, we try and spare those nerves, which we call the nerve sparing prostatectomy. Even with the best efforts in sparing them, there will be people who will have long-term issues with erections because there’s just more to sparing the nerves. That could be injury to the nerves just from the traction of doing the surgery and the healing may not happen,” Dr. Bhandari explains.
With that said, there are steps patients can take to help with longer-lasting side effects — such as pelvic-floor therapy, and medications to help with erections.
Questions To Ask Your Doctor
- Am I a good candidate for robotic surgery?
- What side effects should I be aware of and how will we manage them?
- How many robotic surgeries have you performed?
- What are the risks unique to my case?
- Will I need further treatment afterward?
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