Robotic prostatectomy is a modern, minimally invasive surgical approach used primarily to treat prostate cancer, though it may also be employed for other prostate conditions like severe benign prostatic hyperplasia (BPH). This procedure involves the removal of the prostate gland with the assistance of advanced robotic technology. Unlike traditional open surgery, which requires a large incision, the robotic technique uses small, keyhole-sized cuts in the abdomen. This method removes the diseased tissue while aiming to minimize the impact on surrounding delicate nerves and structures. This article explains the mechanics of the robotic operation, the logistics of the hospital stay, and functional expectations during recovery.
Performing the Operation: The Robotic Technique
The operation is performed using a sophisticated robotic system that provides the surgeon with enhanced visualization and dexterity. The surgeon does not stand at the operating table but instead sits at a console, positioned a short distance away. From this console, the surgeon controls the movements of the robotic arms, which hold miniaturized surgical instruments and a high-definition camera. These instruments are inserted into the patient’s abdomen through several small incisions, typically only 1 to 3 centimeters in length.
The robotic system translates the surgeon’s hand and wrist movements into precise, scaled-down motions inside the patient’s body, allowing for high accuracy. The camera provides a magnified, three-dimensional view of the surgical site, which aids in identifying and preserving the delicate nerves responsible for urinary control and erectile function. The robotic instruments have a far greater range of motion and flexibility than the human hand, which is advantageous when working in the confined space of the male pelvis. The procedure typically takes between two and four hours to complete, depending on the complexity.
The core of the procedure, a radical prostatectomy, involves dissecting and removing the entire prostate gland and the attached seminal vesicles. In cases where the cancer is more aggressive, the surgeon may also remove nearby lymph nodes. Once the prostate is removed, the surgeon must reconnect the remaining urethra to the bladder, a step known as the vesicourethral anastomosis. The precision offered by the robotic system is beneficial during this reconnection, promoting proper healing and the return of urinary function.
Patient Preparation and Immediate Hospital Stay
Preparation for a robotic prostatectomy begins several days before the scheduled date, including pre-operative testing and specific instructions regarding medications. Patients are instructed to stop taking blood-thinning agents, like aspirin and certain supplements, about ten days prior to the procedure. A bowel preparation regimen may also be required the day before surgery to clear the rectum, which creates more space in the abdomen and enhances safety.
On the day of surgery, patients arrive at the hospital a few hours early for check-in and to meet with the surgical and anesthesia teams. Once in the pre-operative area, an intravenous (IV) line is started to administer fluids and medication, and the patient changes into a hospital gown. The surgery is performed under general anesthesia, and the patient is positioned with the head down to allow gravity to shift the abdominal organs away from the pelvis, improving the surgeon’s view.
Immediately after the operation, the patient is moved to a recovery area and then to a hospital room, typically with a urinary catheter in place. Post-operative monitoring focuses on pain control and preventing complications like blood clots; patients are encouraged to sit up in a chair and walk around the ward within hours of the procedure. Most patients are discharged either the same day or the morning after surgery, with the typical hospital stay being only one to two nights.
Recovery and Functional Expectations
The recovery phase begins once the patient is discharged from the hospital and returns home, with the urinary catheter still in place. This catheter is an important part of the healing process, allowing the newly reconnected urethra and bladder to heal without the strain of passing urine. The catheter is usually removed during an outpatient visit, typically five to ten days after the surgery.
Following catheter removal, temporary urinary incontinence is a common and expected side effect, as the muscles responsible for bladder control need time to recover. Patients are encouraged to begin or continue pelvic floor exercises, both before and after surgery, to strengthen the external urinary sphincter. While most patients see significant improvement in urinary control within a few weeks, full continence can take several months to a year to achieve.
Activity restrictions are in place during the initial recovery period to prevent complications like hernias at the incision sites. Patients are advised to avoid heavy lifting or strenuous activity exceeding 15 pounds for about a month. Many patients feel well enough to return to light, desk-based work within two to three weeks of the procedure.
Erectile dysfunction is another potential side effect, as the nerves that control erections run close to the prostate gland. If the cancer allowed for a nerve-sparing approach, the surgeon attempts to preserve these nerve bundles to maximize the chance of recovering sexual function. Full recovery of erectile function is a gradual process that can take anywhere from several months to up to two years. Doctors often recommend a program of penile rehabilitation, which may include daily use of medications to encourage blood flow and facilitate nerve healing.