A robotic simple prostatectomy is a minimally invasive surgical procedure for a non-cancerous enlargement of the prostate gland. The surgery focuses on removing the inner portion of the prostate that obstructs urine flow, leaving the outer part of the gland intact. This approach utilizes a robotic system, which allows the surgeon to perform precise movements through small incisions.
This technique offers a way to address significant prostate enlargement while reducing the recovery time associated with traditional open surgery. It is an option when medications are no longer effective.
Candidates for the Procedure
The primary candidates for this procedure are individuals with moderate to severe urinary symptoms from benign prostatic hyperplasia (BPH) that have not been successfully managed with medication. It is also a viable option for those who have developed complications from BPH, such as urinary retention, recurrent bladder stones, persistent blood in the urine, or kidney issues. Common BPH symptoms that warrant surgery include:
- A frequent or urgent need to urinate
- A weak urine stream
- Difficulty starting urination
- The sensation that the bladder is not fully empty
A defining factor for recommending this surgery is the size of the prostate. It is considered the best option for a significantly enlarged prostate, often larger than 80 to 100 grams. For very large prostates, the robotic approach allows for the removal of more tissue than is feasible with other methods. The surgeon’s assessment of the patient’s overall health and the specific anatomy of the prostate are also part of determining candidacy.
The Surgical Process
The robotic simple prostatectomy is performed under general anesthesia. The surgical team makes several small incisions in the abdomen, which serve as entry points for a camera and specialized instruments attached to robotic arms. The surgeon sits at a nearby console, viewing a magnified, high-definition 3D image of the surgical area and manipulating the robotic arms, which translate their hand movements into precise motions.
The first step involves moving the bladder to access the prostate gland. The surgeon then makes an incision into the prostate’s outer layer, or capsule, to expose the enlarged inner tissue, known as the adenoma. This obstructing tissue is the source of the urinary blockage.
The adenoma is carefully separated and shelled out from the prostatic capsule using meticulous dissection that helps preserve surrounding structures. Once the tissue is fully enucleated, it is placed into a specimen bag and removed through one of the small incisions. The surgeon then sutures the prostate capsule to close it and control any bleeding.
A urinary catheter is inserted through the urethra into the bladder to allow urine to drain while the area heals and helps mold the new urinary channel. A temporary drain may also be placed near the surgical site to prevent fluid buildup. The entire operation takes a few hours to complete.
Post-Operative Recovery
After the surgery, patients remain in the hospital for one to two nights for monitoring. Pain is managed with medication, and patients are encouraged to walk soon after the procedure to promote circulation and prevent complications like blood clots.
A urinary catheter placed during surgery is necessary to allow the bladder and urethra to heal. This catheter remains in place for one to two weeks after the patient goes home and is removed during a follow-up appointment.
During the recovery period at home, certain restrictions are necessary to ensure proper healing. Patients are advised to avoid strenuous activities and heavy lifting for four to six weeks. Driving is usually permitted after about a week, provided the patient is no longer taking prescription pain medication and feels comfortable. A gradual return to normal daily routines is expected, with many able to go back to non-physical work within a couple of weeks.
It is common to experience some temporary urinary symptoms after the catheter is removed. These can include discomfort during urination, urinary frequency, or urgency. Small amounts of blood in the urine may also be present intermittently for several weeks, but these issues resolve as the body continues to heal.
Long-Term Outcomes and Risks
The long-term prognosis after a robotic simple prostatectomy is very positive, with most patients experiencing a significant and lasting improvement in their urinary symptoms. The removal of the obstructing prostate tissue leads to a stronger urine flow and more complete bladder emptying, which improves overall quality of life. Because the outer shell of the prostate is left behind, routine monitoring for prostate cancer remains necessary.
One of the most common long-term side effects is retrograde ejaculation, also known as a dry orgasm. This occurs because the internal bladder opening no longer seals tightly during ejaculation, causing semen to travel backward into the bladder. This condition is not harmful and does not affect the sensation of orgasm, but it does result in infertility.
More serious complications are less common but can occur. Surgeons make every effort to avoid damaging the nerves responsible for erections that run alongside the prostate. Potential risks include:
- Urinary incontinence, such as leakage during activities like coughing or lifting, which is often temporary
- Erectile dysfunction, with full recovery taking several months to years and not always guaranteed
- Significant bleeding or infection
- The formation of scar tissue that could require further procedures