What happens during a robotic prostatectomy? 

During a robotic prostatectomy, a surgical robot is used to remove the prostate gland. The surgeon controls the robot’s arms, which are equipped with specialized surgical instruments, from a console in the operating room. Small incisions are made in the abdomen to insert the robotic arms and a camera. The surgeon uses the robot to precisely remove the prostate while minimizing damage to surrounding tissues. The bladder neck is then sutured to the urethra to restore the continuity of the urinary tract. 

Based on your experience, why is this the best approach? 

Robotic prostatectomy is considered a preferred approach for several reasons. The robotic system offers enhanced visualization, precision, and dexterity, allowing for more precise removal of the prostate while minimizing damage to surrounding structures. This minimally invasive technique generally leads to less blood loss, reduced pain, shorter hospital stays, and faster recovery compared  to traditional open surgery. However, it is important to note that the robot does not perform the operation by itself automatically. It is totally controlled by the surgeon. Therefore, an experienced surgeon is critical in the successful execution of the operation. Many surgeons could perform radical prostatectomy with other approaches, such as laparoscopic or open radical prostatectomy. 

Typically, how long is the surgery? 

The duration of robotic prostatectomy surgery can vary depending on various factors, including the complexity of the case and the surgeon’s experience. On average, the surgery takes around two to three hours. However, it’s important to note that the time in the operating room may be longer when accounting for preoperative preparation and postoperative recovery. 

Will you be removing lymph-nodes to check for spread of cancer? 

Yes, it is common to remove lymph nodes during a robotic prostatectomy. Lymph nodes in the pelvic area are typically removed and examined for the presence of cancer cells. This helps determine if the cancer has spread beyond the prostate gland. On the other hand, most urologists will utilize risk calculators to assess the risk of lymph node involvement. Lymph nodes dissection could be omitted in low risk cases. 

What about preserving urinary continence? 

Preserving urinary continence is a priority during robotic prostatectomy. The surgeon takes great care to preserve the nerves responsible for urinary control. However, there is a risk of temporary or permanent urinary incontinence following surgery, which can vary depending on several factors such as age, preoperative continence status, and the extent of the cancer. Pelvic floor muscle exercise is the mainstay of management to tackle the issue of urinary incontinence after surgery. 

What are the likely or possible side effects of the surgery – both short term and long term? 

The possible side effects of robotic prostatectomy can include short-term effects such as pain, bleeding, infection, blood clots, and temporary urinary incontinence. Long-term side effects may include urinary incontinence (ranging from occasional leakage to more persistent issues) and erectile dysfunction (which can improve over time, especially with nerve-sparing techniques and rehabilitation). 

Generally, what is the success rate for robotic prostatectomy? 

The success rate of robotic prostatectomy depends on several factors, including cancer stage, grade, and individual patient characteristics. The surgeon factor is also important. Generally, robotic prostatectomy has been associated with high rates of cancer control and a low risk of cancer recurrence. However, it’s important to discuss your specific case and prognosis with your urologist to get a more accurate understanding of your expected outcomes. 

How long will it take before I return to normal activities, including sex? 

The time it takes to return to normal activities, including sexual function, after a robotic prostatectomy can vary from person to person. 

In terms of resuming normal activities, most patients are able to gradually increase their activity levels within a few weeks following the surgery. Light activities, such as walking, can usually be resumed soon after the procedure, but it’s important to avoid strenuous activities, heavy lifting, or vigorous exercise during the initial recovery period. 

Regarding sexual function, it’s common to experience temporary erectile dysfunction (ED) after robotic prostatectomy due to the temporary disruption of nerve pathways involved in erections. Recovery of sexual function varies, and some patients may see improvements within a few weeks or months, while for others, it may take longer. 

It’s important to have open and honest discussions with your healthcare provider regarding sexual expectations, concerns, and potential treatment options. 

The recovery of urinary continence is also another critical aspect. Pelvic floor muscle exercise is to be started as early as possible to expedite the return of adequate strength of the pelvic floor muscles and urethral sphincter. 

If there is no other unexpected complications, the patient should be able to return to normal daily activities (non strenuous) after 1-2 weeks.