What is robotic prostatectomy?
Robotic prostatectomy is an advanced surgical technique for prostate removal. It is used to remove the prostate gland in men with prostate cancer.
This type of prostate cancer surgery is a minimally invasive procedure. It uses a robotic system to assist surgeons in operating with greater precision and control.
Your doctor or the healthcare literature may refer to this procedure via an acronym:
- robotic prostatectomy (RARP)
- robotic-assisted laparoscopic radical prostatectomy (RALP)
Why is this procedure performed?
Most prostate surgery is performed robotically nowadays. Robot technology has advanced many times. The most recent version offers significant improvements in vision. Additionally, it enables a more precise, careful, and delicate approach to the surgery. Additionally, this method causes minimal discomfort. Lastly, patients recover much more quickly than from an open approach.
You may hear this robotic-assisted surgery called “Da Vinci robotic” or “Da Vinci surgical system.” This is the brand name of one of the tool options.
What is the difference between a single-port and multi-port robotic prostatectomy?
First, let’s define “port.” In this case, “port” means “incision” or a surgical cut. The port is how the surgical instruments enter your body to do their work. Surgeons can choose between one port (single-port) or several ports (multi-port).
Multi-port is the standard robotic approach that has been used for almost 20 years. It uses 5-7 very small incisions (most tiny incisions are 1/3 of an inch or less).
A single-port operation requires one 1.5″ incision. This is an excellent option for patients who have had major or a lot of abdominal surgery in the past. It’s a good option because it allows your surgeon access without requiring an incision in the abdominal cavity.
Who is the ideal candidate for a robotic prostatectomy?
The ideal candidate for RARP robotic prostatectomy is a man who:
- Has a life expectancy of at least ten years.
- Is typically under 70-80 years old.
- Has not had previous pelvic radiation therapy.
- Is of a normal weight (BMI under 30).
- Has not had extensive prior abdominal surgery.
- And does not have advanced cancer (avoiding Gleason scores of 8-10 or T3-T4 stage disease).
How is a robotic prostatectomy performed?
You will be given general anesthesia. Once you are sedated (“asleep”), your abdominal cavity is filled with gas. The gas expands your abdomen to create a working space. Either one or several small incisions (ports) will be made to allow the robotic arms to work through. The surgeon will sit at a console in the room to control the robot.
Your prostate is between your bladder and the urethra in your penis. During this procedure, your prostate will be carefully removed. Extra care will be taken to protect the nerves that help you achieve erections. Your bladder will then be reconnected to your urethra.
What is the success rate of a robotic prostatectomy?
A robotic prostatectomy is an extremely effective surgery. Most men will still have no evidence of disease five to ten years after surgery. One key consideration is that this surgery is significantly harder to perform and less successful after radiation therapy.
What are the risk factors of a robotic prostatectomy?
An RARP radical prostatectomy has risks like all surgeries. The primary risks include those associated with anesthesia, bleeding, and infection. Because your bladder has to be reconnected, there is a risk that this connection will leak. There is also the risk of leakage from the remaining lymph channels if a lymph node dissection is performed.
What is recovery from a robotic prostatectomy like?
Recovery time is usually short. Most patients stay one night in the hospital, although it is sometimes an option to go home the day of surgery. We always advise our patients to expect some pain, similar to the discomfort experienced after doing a lot of sit-ups after a period of inactivity.
But the pain should not be much worse than that. Patients typically recover very well and are often surprised by how well they feel after surgery, surpassing their initial expectations.
Return to normal activities is generally 2-3 weeks.
Are there other procedures to consider instead of this to treat certain conditions?
Yes. Radiation is another treatment for prostate cancer. Some patients are not fit for surgery, and radiation is a particularly good option for these patients. However, this makes surgery much more complicated if any further indication exists.
There are also focal therapy options like HIFU and TULSA. These choices are something to consider in carefully selected patients with low to favorable intermediate-risk prostate cancer that is confined to just a part of the gland, and who do not want to monitor the tumor actively but prioritize their erections.
What sets Tower Urology apart from other practices when it comes to robotic prostatectomy surgery?
One critical factor in the success of RARP is the surgeon’s experience doing the procedure. Tower Urology has multiple fellowship-trained urologic oncologists and surgeons. These surgeons have decades of expertise in robotic radical prostatectomy and other technologies for treating PCA.
Radical prostatectomy will cure prostate cancer in most cases. Even though it is a minimally invasive surgery, it is still a major procedure, and there are risks. The main risk is erectile dysfunction. There is the possibility that your erectile function (ability to get an erection) will be worse than it was before surgery. Additionally, even with nerve-sparing surgery, urinary incontinence remains a risk.
However, these risks can be minimized with a surgeon who is highly skilled in this procedure. Overall, our patients do extremely well after this surgery and are usually pleasantly surprised by the smooth recovery process.
What makes Tower Urology unique in providing robotic prostatectomy in Los Angeles?
We take a personalized, evidence-based approach to general urology care at Tower Urology. All our professionals at Tower Urology are committed to giving you expert care. We take the time to understand you so that we can personalize your treatment plan to your specific needs.
We invite you to establish care with Tower Urology.
Tower Urology is conveniently located for patients throughout Southern California and the Los Angeles, including Beverly Hills, Santa Monica, West Los Angeles, West Hollywood, Culver City, Hollywood, Venice, Marina del Rey, Burbank, Glendale, and Downtown Los Angeles.
Our services include treatment options for benign prostatic hyperplasia (BPH), male infertility, chronic testicular pain, low testosterone, and prostatitis.
Robotic Prostatectomy FAQs
Urologists are the primary surgeons who perform prostatectomies. These specialized doctors have extensive training and experience in urological procedures, including various types of prostate surgeries. Some key points about surgeons performing prostatectomies include:
- Expertise: Urologists at major medical centers, such as Tower Urology at Cedars-Sinai Medical Center in Los Angeles, often have vast experience in all forms of prostatectomy, performing a high volume of procedures each year.
- Advanced techniques: Many urologists, including those who perform robotic prostatectomy at Tower Urology, are trained in minimally invasive techniques, including robot-assisted prostatectomy, which offers benefits such as faster recovery and lower risk of complications.
- Subspecialization: Some urologists specialize in oncology, focusing specifically on cancers of the urinary system, including prostate cancer. This also applies to the surgical urologists at Tower Urology in Los Angeles.
- Multidisciplinary approach: In Tower Urology, as in many cancer centers, urologic oncologists work as part of a team that includes other specialists to provide comprehensive prostate cancer care.
Robotic prostatectomy (RARP or RALP) demonstrates high success rates across multiple outcome measures.
When choosing a qualified robotic prostatectomy surgeon, several key factors should be considered to ensure the best possible outcomes:
Experience and Expertise
Look for surgeons with:
- Extensive experience performing robotic prostatectomies, ideally hundreds or thousands of cases.
- Fellowship training specifically in robotic surgery and urologic oncology.
- High surgical volume (over 100 RARP cases per year).
- Board certification in urology or oncology.
Surgical Outcomes
Evaluate the surgeon’s track record regarding:
- Cancer control rates and favorable surgical margin rates.
- Continence preservation success rates.
- Potency preservation, particularly with nerve-sparing techniques.
- Complication rates and patient satisfaction scores.
Technology and Facilities
The surgeon should:
- Have access to the latest robotic technology and equipment.
- Work at a facility with comprehensive support systems.
- Practice at a center that specializes in urologic procedures.
Tower Urology in Los Angeles
Tower Urology stands out as an excellent option for robotic prostatectomy in Los Angeles:
- Their physicians have completed extensive training in urologic surgery with additional specialization in specific areas of urologic science.
- They employ a team approach where physicians consult frequently and work cooperatively in patient care.
- Their surgeons are pioneers in robotic surgery with specialized fellowship training in open and minimally invasive techniques.
Notable Tower Urology surgeons include:
- Dr. David Josephson, who has performed over 1,100 robotic procedures and is recognized as a leader in nerve-sparing techniques to improve potency and continence outcomes after robotic prostatectomy.
- Dr. Premal Desai, who completed fellowship training at the Mayo Clinic and specializes in robot-assisted radical prostatectomy for prostate cancer.
Tower Urology offers advantages including smaller incisions, less pain, less blood loss, shorter hospital stays, quicker recovery, better visualization, shorter catheter time, quicker return to continence, and quicker return to normal sexual function compared to traditional open surgery.
Additionally, they offer advanced diagnostic capabilities like Targeted MRI/Ultrasound Fusion Biopsy, positioning them at the forefront of prostate care technology.
When consulting with potential surgeons, ask specific questions about their experience, outcomes, and approach to robotic prostatectomy to make an informed decision.
Sources
Robotic Prostatectomy: Procedure, Efficacy, and Recovery
https://www.healthline.com/health/prostate-cancer/robotic-prostatectomy
Policy guidelines suggested for robot-assisted prostatectomy
https://pmc.ncbi.nlm.nih.gov/articles/PMC4247434/
Robotic radical prostatectomy: outcomes of 500 cases
https://pubmed.ncbi.nlm.nih.gov/17437441
Effects of robotic surgery experience on open radical prostatectomy outcomes
https://www.nature.com/articles/s41598-024-80141-7
Robotic Prostatectomy
https://pmc.ncbi.nlm.nih.gov/articles/PMC1480556/
