Robot-assisted laparoscopic radical prostatectomy

Robot-assisted laparoscopic radical prostatectomy is a modern technique for treating localised prostate cancer. Few centres in the UK offer this procedure but many are training to do so.

Laparoscopic surgery; also known as keyhole surgery, uses instruments inserted through narrow hollow tubes ('ports') rather than through a larger incision, as in traditional surgery. This type of surgery has the potential for shorter hospitalisation and convalescence, less bleeding and post-operative pain, and fewer wound complications, but randomised trials are still needed to assess outcomes.

The first robotic-assisted radical prostatectomy was performed in 2000. In 2007 we talked to a 48-year-old man three months after he had had this new treatment in the National Health Service.

Explains that the robotic device helps to eliminate the surgeon's hand tremor and allows great precision of movement.

Between 2005 and 2006 he had had some urinary symptoms, had a raised PSA (about 12 ng per ml.), was referred to a consultant and had a prostate biopsy. During the biopsy and other investigations his privacy and dignity were not always respected (see 'Biopsy').

Having been given the diagnosis of prostate cancer he found out about different treatment options and decided which would suit him best.  

How he decided to have this new type of surgery.

The pre-operative assessment took place two weeks before the operation.

He was in hospital for three days. On the first day he had more investigations and was seen by various doctors, including the anaesthetist, and by a specialist urology nurse. He had prepared for the procedure by doing pelvic floor exercises for 2-3 weeks pre-operatively.

The specialist urology nurse made sure he knew how to do pelvic floor exercised correctly.

The operation went smoothly and he had no pain when he woke up from the anaesthetic.

A catheter was inserted during the operation, and a drain attached to a tube on one side of the abdomen. On the first post-operative day he got out of bed unaided and could go home that afternoon.

He got out of bed the next day and went home with a supply of two different types of catheter bag.

He recovered quickly and was able to go outside for a short walk two days after returning home. He had to take medication which led to diarrhoea.

Long-term data about urinary continence and erectile function after surgery are not yet available, but studies presenting data at follow up longer than 12 months have reported continence rates of between 84% and 98%. The man we talked to had his catheter removed after 10 days. He stayed one night in hospital after the catheter had been removed and was pleased to find that he had not been incontinent. He was glad that he had done the pelvic floor exercises before his operation. 

He was delighted to find that he was not incontinent after the catheter had been removed. He was off work for only four weeks.

Available 12-month follow-up data suggest that between 20% and 97% of men can have sexual intercourse after nerve sparing robot-assisted laparoscopic prostatectomy. The surgical technique and the patient's age can influence these results. 

The man we talked to was glad he had chosen this type of treatment. Three months after surgery his PSA reading was 0.1ng per ml. He will continue to have regular check-ups. 

It is important to note that this is only one man's experience of robot-assisted laparoscopic radical prostatectomy. More research is needed to assess the harms and benefits of treatment.

Laparoscopic and robot-assisted prostatectomy are seen as more expensive then open surgery because of the expense of the equipment and therefore some NHS Trusts will not cover the cost of the surgery.

For more information see an article by V. Ficarra and colleagues called “Evidence from Robot-Assisted Laparoscopic Radical Prostatectomy: A Systematic Review”, which can be found in European Urology 2007, volume 51, pages 45-56.

Last reviewed January 2012

Last updated January 2012