Robot-Assisted Radical Prostatectomy, or RARP, is a minimally invasive surgical procedure for treating prostate cancer. It involves the removal of the prostate gland and nearby tissues using a robotic system. The primary goal is to remove the cancer entirely while aiming to maintain urinary control and sexual function. This procedure enhances precision and can reduce recovery time compared to traditional surgery.
The Robotic-Assisted Surgical Procedure
The RARP procedure is performed with the patient under general anesthesia. The surgeon operates from a console, controlling a set of robotic arms with specialized instruments. A series of small incisions are made in the patient’s abdomen, which serve as ports for a high-definition 3D camera and the surgical instruments.
The abdomen is inflated with carbon dioxide gas, creating space for the surgeon to work. Guided by the magnified, three-dimensional view, the surgeon manipulates the robotic arms. These instruments have a greater range of motion than the human hand, allowing for precise movements to dissect the prostate gland and attached seminal vesicles from the bladder and urethra.
If necessary for the cancer’s risk profile, the surgeon may also remove pelvic lymph nodes to check for cancer spread. A nerve-sparing technique may be used, where the surgeon works to preserve the bundles of nerves responsible for erections. After the prostate is detached, it is removed through one of the incisions. The final step is reattaching the urethra to the bladder neck.
Determining Candidacy for RARP
A patient’s suitability for RARP depends on the specifics of their cancer and their overall health. This surgery is most commonly recommended for individuals with localized prostate cancer, meaning the tumor has not spread beyond the prostate gland. The stage and grade of the cancer are assessed through diagnostic tests like Prostate-Specific Antigen (PSA) blood levels, biopsy results (Gleason score), and imaging studies.
A patient’s general health, including age and any coexisting medical conditions, also plays a role. Surgeons will consider whether a patient has had previous major abdominal surgeries, as scar tissue might complicate a robotic procedure. The decision is a collaborative one between the patient and their medical team.
Post-Operative Recovery and Outcomes
Following the surgery, patients remain in the hospital for one to two days. A urinary catheter, placed during the operation to allow the reconnected urethra and bladder to heal, will be in place for about five to ten days. Patients are encouraged to start walking within hours of the surgery to promote recovery.
Once at home, recovery continues with a gradual return to normal activities. Driving is discouraged until after the catheter is removed, and more strenuous physical activities are restricted for around four weeks. Pain is generally mild and can be managed with prescribed medication.
Two significant considerations after RARP are its effects on urinary control and erectile function. Most men experience some urinary incontinence immediately after the catheter is removed, but this improves steadily over the following months. Recovery of erectile function is more variable and depends on the patient’s age, pre-surgery function, and whether a nerve-sparing technique was performed.
Alternative Prostate Cancer Treatments
When considering treatment for localized prostate cancer, RARP is one of several available options. Other common approaches include:
- Open radical prostatectomy, a traditional surgery involving a single, larger incision that may lead to more blood loss and a longer recovery period.
- External beam radiation therapy, which uses high-energy rays from outside the body to destroy cancer cells.
- Brachytherapy, a form of radiation that involves placing small radioactive seeds directly into the prostate gland.
- Active surveillance, which involves closely monitoring low-risk, slow-growing cancer and deferring treatment unless it shows signs of progressing.