Robotic Radical Prostatectomy

The Prostate: A small gland of the male reproductive system, approximately the size of a walnut, located below the bladder and in front of the rectum.

The Urethra: The canal that carries urine from the bladder out of the body passes through the center of the prostate.

Function: Its main function is to produce part of the fluid that makes up semen.

Prostate Cancer: Occurs when cells in the prostate begin to grow in an uncontrolled and invasive manner.

Definition: Radical prostatectomy is a surgical procedure involving the complete removal of the prostate gland and the seminal vesicles (small glands attached to the prostate that also contribute to semen).

Lymphadenectomy: In many cases, especially if the cancer has higher-risk characteristics, nearby pelvic lymph nodes (which can be the first site of cancer spread) are also removed during the same surgery.

Main Objective: The primary goal is to remove all cancerous tissue with the intent of curing the prostate cancer.

Indications: It is a treatment of choice for men with clinically localized prostate cancer. In some selected cases of locally advanced disease, it may be part of a multimodal treatment strategy (combined with radiotherapy or hormone therapy).

How It Works:

• The surgery is performed under general anesthesia.
• Several small incisions (usually 5 to 6, about 0.5 to 1 cm each) are made in the patient’s abdomen.
• Through these incisions (“ports”), small tubes are inserted to allow the passage of a high-definition video camera and miniaturized surgical instruments.
• The surgeon does not operate directly on the patient but from an ergonomic console located in the same operating room.
• At this console, the surgeon has a magnified 3D high-definition view of the interior of the patient’s pelvis.
• The surgeon controls robotic arms that hold the instruments. Their hand movements are translated in real-time into precise, delicate movements inside the body.
• The system filters out any natural hand tremors and allows for a range of motion exceeding that of the human hand.

Differences from Open and Conventional Laparoscopic Surgery:

• Open Surgery: Involves a single larger abdominal incision (usually from below the navel to the pubic bone).
• Conventional Laparoscopy: Uses small incisions and long instruments, but the surgeon operates looking at a 2D monitor, and the instruments do not have the same articulation as robotic ones.
• Robotic Surgery: Combines the advantages of laparoscopy (small incisions, less trauma) with cutting-edge technology providing superior 3D vision, greater precision, better ergonomics, and highly articulated instruments for complex maneuvers.

Magnified 3D HD Vision: Provides an exceptionally clear view of pelvic anatomy, including delicate neurovascular bundles (for erectile function) and the urinary sphincter (for continence).

Greater Precision and Dexterity: Robotic instruments (EndoWrist®) have joints that mimic and exceed the human wrist, allowing fine movements in confined spaces.

Nerve Preservation: Superior visualization allows for a more careful dissection and a higher probability of preserving nerves responsible for erection (nerve-sparing), when oncologically safe.

Sphincter Preservation: Better preservation of the urinary sphincter structure and urethral length, crucial for faster recovery of continence.

Precise Reconstruction: The connection (anastomosis) between the bladder and the urethra can be performed with great precision, essential for healing and continence.

Clinical Benefits: Less blood loss (lower transfusion risk), less post-operative pain, shorter hospital stay (1 to 3 days), faster recovery, and better aesthetic results (smaller scars).

Men with a diagnosis of clinically localized prostate cancer.

Men with a reasonable life expectancy (usually over 10-15 years) to benefit from the long-term cure.

Men in adequate physical condition to tolerate general anesthesia and the specific surgical position (Trendelenburg, with the head lower than the feet).

Pre-Anesthesia Consultation: Evaluation by the anesthesiologist.

Pre-Operative Exams: Blood tests, electrocardiogram (ECG), and other necessary tests.

Medication Adjustment: Anticoagulants or antiplatelet agents (e.g., aspirin, clopidogrel) may need to be suspended days before surgery under medical guidance.

Fasting: Necessary for several hours before surgery.

Anesthesia: Performed under general anesthesia.

Incisions and Insufflation: Small incisions are made, and the abdomen is insufflated with CO2 to create a workspace.

Robotic Docking: Robotic arms are introduced through the ports and coupled to the system.

Surgery: The surgeon removes the prostate and seminal vesicles, and if indicated, the pelvic lymph nodes.

Reconstruction: The bladder is sutured to the urethra (urethrovesical anastomosis) over a urinary catheter.

Pathological Analysis: The removed tissue is sent to a lab to confirm cancer extension and surgical margins.

Hospital Stay: Usually 1 to 3 days.

Urinary Catheter: Stays in place for 7 to 14 days to allow the suture to heal.

Early Mobilization: Encouraged to walk as soon as possible to prevent complications like thrombosis.

Diet: Restarted progressively, beginning with liquids.

Recovery at Home: Fatigue is normal for the first few weeks. Avoid heavy lifting or intense efforts for 4 to 6 weeks.

Kegel Exercises: Pelvic floor exercises are highly recommended to help recover urinary continence.

Oncological Control: After successful surgery, PSA levels should drop to undetectable values (usually <0.1 ng/mL) within 4 to 6 weeks.

Urinary Incontinence: Involuntary leaks are common immediately after catheter removal. Most men regain good control within 6 to 12 months.

Erectile Dysfunction: The ability to have an erection may be affected. Recovery can be gradual, sometimes taking 1 to 2 years, and can be aided by penile rehabilitation programs.

Other Risks: Infection, bleeding (rare with robotics), injury to adjacent organs (very rare), or hernia.

Periodic consultations.

Regular PSA tests (every 3-6 months in the first years, then annually).

Evaluation and management of urinary and sexual function.

Robotic radical prostatectomy is a highly effective and safe treatment. If you have been diagnosed with prostate cancer, I invite you to schedule a consultation so we can discuss your specific case and help you make the most informed decision for your health and well-being.