Robotic-assisted simple prostatectomy (RASP) is a minimally invasive surgical procedure to remove an enlarged prostate gland. This approach utilizes a robotic system, allowing surgeons to operate through several small incisions. RASP addresses prostate enlargement by precisely removing the obstructing tissue.
Understanding Benign Prostatic Hyperplasia (BPH)
Benign Prostatic Hyperplasia (BPH) describes a non-cancerous enlargement of the prostate gland, a common condition affecting many men as they age. The prostate surrounds the urethra, the tube that carries urine out of the body, and its enlargement can compress this tube. Studies indicate that approximately 50% of men over 50 experience some degree of prostate enlargement, increasing to about 90% by age 80.
This compression can lead to bothersome urinary symptoms. Common symptoms include frequent urination, especially at night (nocturia), a sudden and strong urge to urinate, a weak or interrupted urine stream, and the sensation of incomplete bladder emptying. These symptoms can disrupt sleep patterns, leading to daytime fatigue and reduced productivity.
Beyond the physical discomfort, BPH symptoms can also cause psychological distress, such as increased stress levels, anxiety about finding restrooms, and embarrassment in social situations. The constant worry about urinary issues can limit participation in favorite activities and negatively impact overall well-being. When lifestyle changes and medications are no longer effective, surgical intervention like RASP may be considered to relieve these symptoms.
The Robotic-Assisted Simple Prostatectomy Procedure
The robotic-assisted simple prostatectomy (RASP) is performed under general anesthesia. The surgeon then makes several small incisions in the abdomen.
Through these small incisions, miniaturized robotic instruments and a three-dimensional endoscope are inserted. The da Vinci Surgical System is a commonly used platform, where the surgeon controls the robotic arms from a remote console. This system translates the surgeon’s movements with enhanced precision, providing a magnified, high-definition view of the surgical field.
During the procedure, the surgeon removes the inner part of the enlarged prostate gland, known as the adenoma, while leaving the outer capsule intact. This removal of the obstructing tissue is called enucleation. The approach can be either transvesical (through an incision in the bladder) or transcapsular (through the prostate capsule). A common technique involves a vertical incision in the bladder wall (cystotomy) to access the prostatic adenoma, which can be extended into the prostate if needed to facilitate removal and provide good exposure to the bladder neck and ureteric orifices.
Once the adenoma is removed, the prostatic fossa is inspected for bleeding, and sutures are placed to control major arteries. The bladder neck is reconstructed using sutures to ensure a tension-free and watertight closure of the bladder incision. This minimally invasive technique offers advantages over traditional open surgery, including smaller incisions, reduced blood loss, and quicker recovery.
Recovery and Post-Operative Care
Following a robotic-assisted simple prostatectomy, patients are typically transferred to a recovery area for one to two hours before moving to a hospital room. Most individuals spend one to two nights in the hospital, though some may be discharged the same day. Upon waking, patients will have several small bandages over the incisions, a drain attached to a vacuum container from one incision, and a urinary catheter (Foley) to drain urine from the bladder.
Pain medication is available if needed. Early mobilization is strongly encouraged, with patients advised to sit up and walk short distances on the day of surgery. Regular walking, approximately one mile daily in short intervals, helps prevent blood clots and promotes bowel activity. The intravenous (IV) line and drain are usually removed the day after surgery, and a liquid diet is typically started before progressing to light solid foods as bowel function returns.
The urinary catheter usually remains in place for approximately 5 to 12 days to allow the bladder and urethra to heal. Patients receive instructions on catheter care and may experience bladder spasms, which can cause cramping or urgency, but these are usually manageable. Driving is generally permitted once off narcotic pain medication and after the catheter is removed, typically around 2 to 3 weeks post-surgery.
Return to work varies based on the individual’s recovery and occupation, often ranging from 2 to 4 weeks for sedentary jobs, and 4 to 6 weeks for more physically demanding roles. Lifting restrictions apply, usually no more than 10 pounds for the first 4 weeks, and no more than 50 pounds for 6 weeks. Patients should avoid baths, hot tubs, and swimming for about 4 weeks to prevent infection. Follow-up appointments are scheduled to remove the catheter and assess healing and recovery progress.