Robotic-Assisted Radical Prostatectomy

A radical prostatectomy removes the entire prostate gland, its capsule and the seminal vesicles to treat prostate cancer in a man expected to live long enough to benefit. It was once done mainly through an open lower abdominal or perineal incision; the robot-assisted laparoscopic approach has now largely replaced these in many hospitals. With the da Vinci system, four of the six ports carry the robotic arms, and the surgeon works from the console while a bedside assistant handles suction, clips and retraction. A history of extensive abdominal or pelvic surgery, severe obesity or a very large prostate can make the operation harder. This page follows an anterior approach in step order: the bladder is dropped first, the endopelvic fascia is opened, the bladder neck is divided, the seminal vesicles and the plane above the rectum are developed, and the pedicles and nerve bundles are taken without clips to avoid traction. The dorsal vein and urethra are cut without a stapler and oversewn, and the bladder neck is joined to the urethra with a posterior (Rocco) reconstruction and a single-knot running anastomosis. Steep Trendelenburg, lithotomy and long console time make positioning and padding a large part of the setup. The page "Robotic-Assisted Prostatectomy with Pelvic Lymph Node Dissection" covers the variant in which pelvic lymph nodes are removed. Most men go home the next morning with a urinary catheter, which stays in for about a week. Common problems after surgery include lymph fluid collections (lymphocele), urine leak at the anastomosis, bleeding and reoperation. Urinary control usually returns over weeks to months, while erections can take one to two years. An inguinal hernia is found in about one man in five in reported cases and can be repaired during the same operation, and vertical port-site incisions can lead to incisional hernias.