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Robotic Radical Prostatectomy

Cleveland Clinic's advanced robotic radical prostatectomy procedure offers many benefits over open surgery. Learn more from the experts at Cleveland Clinic.

What is Robotic Radical Prostatectomy?

Learn more about Cleveland Clinic’s nationally top-ranked urology program.

Robotic radical prostatectomy is a type of minimally invasive surgery which uses surgical robotic equipment to remove the entire prostate. The robotic laparoscopic technique allows surgeons to operate through small ports rather than large incisions, resulting in shorter recovery times, fewer complications and reduced hospital stays. Surgical robotics combines minimally invasive techniques with highly advanced clinical technology.

Further, robotic surgery provides 3D vision and precise direction that allow for nerve sparing. In cases where wide excision of the prostate and nerve is planned prior to surgery and discussed with the patient, then a sural graft of the nerve is an option.

How does new robotic technology assist the surgeon during radical prostatectomy?

The three-dimensional vision system magnifies the surgical field up to 15 times and improves the ability of the surgeon to recognize and control small blood vessels, thereby reducing blood loss. Because of robotic technology, surgeons are able to perform minimally invasive procedures with more precision. Robotic arms remain steady at all times and robotic wrists make it easier for surgeons to manipulate tissue and work from all kinds of angles - positions surgeons would have difficulty reaching otherwise.

Why Would Someone Need a Robotic Radical Prostatectomy?

Majority of people with prostate cancer are candidates for robotic surgery, however you and your surgeon will be able to determine what course of prostate treatment is right for you. Typically, best results from robotic radical prostatectomy occur if performed when your prostate cancer is in state T1 or T2 (meaning that it is confined to your prostate). However, there is no cut-off, and many patients do have improved outcomes even in later cancer stages as a result of the procedure.

What Happens Before Robotic Radical Prostatectomy?

Your Cleveland Clinic doctor will provide you with specific instructions for how to prepare for surgery. Because each patient is unique, your doctor will help guide you through each step of the surgical process. However, there are some common ways that patients are to prepare for surgery. This includes modifying your diet, preparing your bowels, and modifying medication/supplement routine.

You will be asked to stop eating or drinking anything besides a clear liquid diet the day prior to surgery. Doctors recommend you abstain from drinking anything after midnight the day prior to surgery. If your doctor has prescribed medication for you to take, you'll be expected to take them with a small sip of water.

You'll be asked to stop taking blood thinning medications (such as aspirin, Coumadin, or Plavix) one week prior to surgery. However, it is important for you to listen to your doctors instructions regarding changing your medication routine, every patient is different.

Cessation of tobacco smoking is also vital for the healing process. Tobacco limits the flow of oxygen through the body which is needed to heal faster.

What Happens During Robotic Radical Prostatectomy?

Jihad Kaouk, MD, discusses innovative minimally invasive and robotic procedures.

You will be given general anesthesia so you will not be aware of the surgical procedure. After which you'll also be given antibiotics by injection to help prevent
infection.

The surgeon will make 5 small incisions in the lower abdomen through which the robotic controlled camera and other arms will be passed to perform the procedure. Your surgeon will operate a console and manipulate the robot system which will allow a very clear view of the operation and very fine movement controls. The surgeon will remove your prostate through one of the keyhole incisions and will perform intracorporeal suturing (sewing inside the body) to minimize risks of complications.

What Happens After Robotic Radical Prostatectomy?

After surgery, you'll be guided to a recovery room where our expert staff will monitor your condition and treat you for any post-surgery pain. Our staff will encourage you to walk around after the surgery to help the healing process and discourage blood clots from forming shortly after the surgery.

Will I be incontinent after robotic prostate surgery?

In men, there are 3 main mechanisms to control urine. The bladder neck is cut during surgery to remove the prostate. The prostate itself, which helps continence, is removed. The remaining mechanism left intact to hold urine is the external sphincter. After surgery, patients leak urine, but Kegel's exercises are taught to strengthen the appropriate muscles and gain urine control. We have data that shows 96-98% of patients are continent (have good bladder control) after surgery.

What are the sexual side effects after robotic prostate surgery?

The degree of sexual function after a radical prostatectomy is determined by many factors. These include the patient's age, how sexually active he was before the procedure, how much the surgical procedure affects the nerves and how sexually motivated he is after surgery. Most men experience at least temporary erectile problems after a radical prostatectomy.

When can I exercise after robotic prostate surgery?

Walking will be permitted right after surgery. Heavier exercise should be postponed for 3-4 weeks.

As is the case with other minimally invasive procedures, robotic surgery has potential advantages over traditional open surgery:

  • Length of hospitalization is often shortened to one or two days.
  • The three-dimensional vision system magnifies the surgical field up to 15 times and improves the ability of the surgeon to recognize and control small blood vessels, thereby reducing blood loss.
  • There is often no need to prescribe narcotic analgesics on discharge. Patients generally need nothing more than Tylenol.
  • Approximately 90% of patients can return to work or resume full activity in only two to three weeks.
  • For prostatectomy, complete continence (no leakage at all) is obtained in 94% of patients within 6 months.
  • Surgeons are able to perform minimally invasive procedures with more precision.  Robot arms remain steady at all times and robot wrists make it easier for surgeons to manipulate tissue and work from all kinds of angles - positions surgeons would have difficulty reaching otherwise. In this way full functionality of the prostate can be preserved in the vast majority of cases.

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