What Is A Robotic Radical Prostatectomy?



Organ limited prostate cancer can be treated with different methods. For patients who are seeking active treatment, radical prostatectomy (surgical removal of the entire gland) is one of the most effective treatment methods.

Robotic radical prostatectomy is a type of minimally invasive surgery which uses a surgical robot to remove the entire prostate. The robotic laparoscopic technique allows surgeons to operate through small ports rather than large incisions. The robotic vision system delivers 3D high-definition views, giving the surgeon a crystal-clear view of the surgical area that is magnified 10 times to what the human eye sees. Tiny instruments are used that move like a human hand but with a far greater range of motion. The system’s built-in tremor-filtration technology helps the surgeon move each instrument with smooth precision.


What are the Advantages of Robotic Radical Prostatectomy?

 Surgical robotics combines minimally invasive techniques with highly advanced clinical technology, resulting in a couple of advantages listed below. Professor Haluk AKPINAR could have access to this technology since 2005.


  • Earlier return to sexual life 1-5: The degree of sexual function after radical prostatectomy is determined by many factors. These include the patient's age, how sexually active he was before the procedure, how much the surgical procedure affects the nerves and how sexually motivated he is after surgery. Most men experience at least temporary erectile problems after radical prostatectomy. Robotic surgery enables to spare erection nerves alongside the prostate. Patients experience faster return of erectile function than patients who had open surgery.

  • Better urinary control 1-5: After radical prostatectomy majority of the patients leak urine however this is transient and gradually urine control is gained again. Patients experience usually .faster, return of urinary continence than patients who had open within 3 months of surgery. In our robotic series, 92 % of patients have satisfactory bladder control and not using protective pads 3 months after robotic surgery. Risks for post-prostatectomy prolonged incontinence are advanced age, diabetes, non-nerve sparing surgery. Better visualization, less blood loss, and the ability to leave longer urethral length with non-leaking good anastomosis are the reasons for earlier urinary control.

  • Fewer hospital stays and hospital readmission 14-21: Patients may stay in the hospital for a shorter amount of time than patients who had open surgery. In our experience, the length of hospitalization is often shortened to 2 days. Also, when compared to patients who had open surgery, patients undergoing surgery with a robot may have less chance of being readmitted to the hospital after leaving.

  • Fewer complications, blood loss, and transfusion 6-21: The three-dimensional vision system magnifies the surgical field up to 10 times and improves the ability of the surgeon to recognize and control small blood vessels, thereby reducing blood loss. Almost none of the patients in our group required blood transfer. Patients may experience similar or fewer complications after surgery compared to patients who had open surgery.

  1. De Carlo, F., F. Celestino, et al., Retropubic, Laparoscopic, and Robot-Assisted Radical Prostatectomy: Surgical, Oncological, and Functional Outcomes: A Systematic Review. Urol Int, 2014.

  2. Moran, P.S., M. O'Neill, et al., Robot-assisted radical prostatectomy compared with open and laparoscopic approaches: A systematic review and meta-analysis. Int J Urol, 2013. 20(3): p. 312-21.

  3. Pan, X.W., X.M. Cui, et al., Robot-Assisted Radical Prostatectomy vs. Open Retropubic Radical Prostatectomy for Prostate Cancer: A Systematic Review and Meta-analysis. Indian Journal of Surgery, 2014.

  4. Seo, H.J., N.R. Lee, et al., Comparison of robot-assisted radical prostatectomy and open radical prostatectomy outcomes: A systematic review and meta-analysis. Yonsei Medical Journal, 2016. 57(5): p. 1165-1177.

  5. Yaxley, J.W., G.D. Coughlin, et al., Robot-assisted laparoscopic prostatectomy versus open radical retropubic prostatectomy: early outcomes from a randomised controlled phase 3 study. Lancet, 2016

  6. Tewari, A., P. Sooriakumaran, et al., Positive Surgical Margin and Perioperative Complication Rates of Primary Surgical Treatments for Prostate Cancer: A Systematic Review and Meta-Analysis Comparing Retropubic, Laparoscopic, and Robotic Prostatectomy. European Urology, 2012. 62(1): p. 1-15.

  7. Gandaglia, G., J.D. Sammon, et al., Comparative Effectiveness of Robot-Assisted and Open Radical Prostatectomy in the Postdissemination Era. J Clin Oncol, 2014.

  8. Pilecki, M.A., B.B. McGuire, et al., National multi-institutional comparison of 30-day post-operative complication and re-admission rates between open retropubic radical prostatectomy (RRP) and robot-assisted laparoscopic prostatectomy (RALRP) using NSQIP. J Endourol, 2013.

  9. Laird, A., S. Fowler, et al., Contemporary practice and technique-related outcomes for radical prostatectomy in the UK: A report of national outcomes. BJU International, 2015. 115(5): p. 753-763.

  10. Novara, G., V. Ficarra, et al., Systematic Review and Meta-analysis of Perioperative Outcomes and Complications After Robot-assisted Radical Prostatectomy. European Urology, 2012.

  11. Davis, J., U. Kreaden, et al., Learning Curve Assessment of Robot-Assisted Radical Prostatectomy Compared to Open Surgery Controls from the Premier Perspective Database. J Endourol, 2013.

  12. Ellimoottil, C., F. Roghmann, et al., Open versus robotic radical prostatectomy in obese men. Current Urology, 2015. 8: p. 156-161.

  13. Stolzenburg, J.U., I. Kyriazis, et al., National trends and differences in morbidity among surgical approaches for radical prostatectomy in Germany. World J Urol, 2016.

  14. Sugihara, T., H. Yasunaga, et al., Robot-assisted versus other types of radical prostatectomy: Population-based safety and cost comparison in Japan, 2012-2013. Cancer Science, 2014. 105(11): p. 1421-1426.

  15. Trinh, Q.D., J. Sammon, et al., Perioperative Outcomes of Robot-Assisted Prostatectomy Compared With Open Radical Prostatectomy: Results From the Nationwide Inpatient Sample. European Urology, 2012. 61(4): p. 679-85.

  16. Yu, H.Y., N.D. Hevelone, et al., Hospital volume, utilization, costs and outcomes of robot-assisted laparoscopic radical prostatectomy. J Urol, 2012. 187(5): p. 1632-7.

  17. Kim, S.P.S., N. D.; Karnes, R. J.; Weight, C. J.; Shippee, N. D.; Han, L. C.; Boorjian, S. A.; Smaldone, M. C.; Frank, I.; Gettman, M. T.; Tollefson, M. K.; Thompson, R. H., Hospitalization Costs for Radical Prostatectomy Attributable to Robotic Surgery. European Urology, 2012.

  18. Pearce, S.M., J.J. Pariser, et al., Comparison of Perioperative and Early Oncologic Outcomes Between Open and Robotic-Assisted Laparoscopic Prostatectomy in a Contemporary Population-Based Cohort. J Urol, 2016.

  19. Basto, M., N. Sathianathan, et al., A patterns of care and health economic analysis of robotic radical prostatectomy in the Australian public health system. BJU Int, 2015.

  20. Wen, T., C.M. Deibert, et al., Positioning-related complications of minimally invasive radical prostatectomies. Journal of Endourology, 2014. 28(6): p. 660-667.

Monn, M.F., K.R. Jaqua, et al., Impact of Obesity on Wound Complications Following Radical Prostatectomy is Mitigated by Robotic Technique. Journal of Endourology, 2016. 30(8): p. 890-895.