Robot-Assisted Prostatectomy for Prostate Cancer

Early detection of prostate cancer through regular prostate examinations, PSA testing, and, more recently, MRI of the prostate, allows for diagnosis at a stage before the cancer infiltrates the adjacent structures or metastasizes.

At this stage, curative treatment is possible, referring to therapies that can completely cure the cancer. Internationally recognized curative therapies include radical prostatectomy (open, laparoscopic, or robotic) and radiation therapy (external or internal radiation). Both methods have their advantages and disadvantages.

Advantages of robotic radical prostatectomy include:

• Ability to remove the entire prostate with seminal vesicles and lymph nodes, enabling a reliable diagnosis of tumor stage and prognosis.
• Easy tumor follow-up (PSA should not be detectable after prostate removal), facilitating early detection and treatment of recurrence.
• Minimal invasiveness of the procedure and minimal blood loss.
• Shorter hospital stay.
• High rates of continence and potency.

As part of the preoperative preparation, you need clearance from your general practitioner or internist, as well as an ophthalmological examination (measurement of eye pressure). Admission takes place the day before the operation. You will be informed in detail about the procedure and potential complications.

The surgery is always performed under general anesthesia.

The operation is carried out using the so-called keyhole technique. Several small openings (5mm to 12 mm) are made in the abdominal wall to introduce robotic instruments and suture material. The abdominal cavity is filled with gas to create sufficient working space.

The latest-generation DaVinci surgical system provides the surgeon with a 3D image of the surgical area with 10x magnification. This allows precise visualization and preservation of the finest anatomical structures, such as small vessels or nerves. Manipulations are performed precisely with microsurgical instruments and with 7 degrees of freedom. This enables stitching and cutting techniques in hard-to-reach body areas that are almost impossible with other surgical techniques.

During radical prostatectomy, the entire prostate with seminal vesicles and parts of the vas deferens are removed. Depending on the stage of the tumor, a nerve-sparing technique can be chosen, preserving the nerves and vessels responsible for potency in some cases.

Depending on the clinical stage, lymph nodes in the pelvic region are removed.

Subsequently, the urethra is tightly sutured to the bladder neck. To spare this connection, also called anastomosis, a urinary catheter is inserted and blocked with a balloon in the bladder. At the end of the procedure, the specimen is being removed via an extended port in the abdominal wall and sent for histological examination.

The operation usually lasts around two hours.

After the operation, all patients initially go to the recovery ward, where vital signs are closely monitored until transfer to the general ward is possible. On the first and second postoperative days, the patient is mobilized, and the drainage tube is removed. Leakage control of the anastomosis, also known as cystogram, is performed between the fifth and seventh postoperative day. The bladder is filled with contrast medium via the indwelling catheter, and the integrity of the connection between the bladder and the urethra are checked under X-ray. If no leakage is detected, the catheter is removed immediately. Afterward, urination is possible again. Pelvic floor exercises or sphincter training are recommended to improve continence. Discharge takes place the following day. The skin staples can be removed after the seventh postoperative day (either before discharge or in an outpatient setting).

The hospital stay from admission to discharge usually lasts six to eight days.