Robot-assisted radical prostatectomy (RARP) uses the Da Vinci surgical system to enable the surgeon to operate by controlling a series of robotic arms through small incisions in order to remove the entire prostate.
After the prostate is removed, the urinary system is reconstructed by sewing the bladder to the urethra (the tube that drains urine out of the body). The procedure may also include removal of the lymph nodes in the pelvis surrounding the prostate. Robot-assisted procedures enable dramatically faster recovery than traditional open surgery. The vast majority of radical prostatectomies are now performed with the robot-assisted approach.
When to Ask a Urologist about Robot-Assisted Radical Prostatectomy
You should speak with a Urologist about Robot-Assisted Radical Prostatectomy if you have been diagnosed with prostate cancer.
Cost
Typically covered by most insurances (although coinsurance and deductibles may apply). Coverage will be verified prior to proceeding. If you do not have insurance, our office will be able to give you an out-of-pocket cost estimate.
Effectiveness
Cancer outcomes following surgery vary widely based on the precise variables for a given case, including importantly the results from the final pathology postoperatively. The cancer outcomes following surgery for patient specifically can be estimated online with preoperative variables using the Memorial Sloan Kettering Cancer Center nomogram. Cancer-specific survival following surgery is typically very high with rates approaching 99% at 10 years.
Possible Side Effects
The primary risks of RARP include urine incontinence or leakage and damage to erections. Urine control improves over the first 12 months following surgery with about 50% of men using more than 1 pad per day at 3 months postoperatively and about 10% of men using more than 1 pad per day beyond 12 months postoperatively. Postoperative erections are related to preoperative function, patient age and nerve-sparing during surgery, and erections also improve over the first 12 months following surgery. For men with these factors in their favor, about 60% are able to have penetrative intercourse beyond 12 months postoperatively.
Rare risks associated with RARP include damage to the rectum (1%), fluid collection where the lymph nodes are removed that requires temporary drain (1%), urine leak (1%), delayed development of scar tissue at the base of the bladder (1%).
The risks of major abdominal surgery with general anesthesia radical prostatectomy include bleeding (with the possible need for transfusion), infection, damage to adjacent structures, incomplete cancer removal, hernia, stroke, heart attack, blood clot, and a small (<1%) possibility of death.
Alternative Approaches
The most common alternative to RARP is external beam radiation with hormone deprivation therapy. Surgery has several benefits over radiation including precise pathological staging, straightforward follow-up with PSA levels, and the ability to offer radiation in the event of a recurrence. Other alternatives to RARP include observation without treatment, active surveillance, brachytherapy, primary hormone therapy, cryoablation, and traditional open radical prostatectomy. Although focal therapy, with high-intensity ultrasound for example, is an area of intense research, it is not currently considered the standard of care and is not FDA approved to treat prostate cancer.
What to do to Prepare for Surgery
You will receive detailed instructions from the surgical schedulers regarding any necessary testing or appointments prior to surgery. In general, you should temporarily stop blood-thinning medications prior to surgery (when to stop depends on the type of blood thinner). Prescription blood-thinning medications should be stopped following clearance from the doctors that prescribed them though other medications that thin the blood including fish oil and pain relievers such as ibuprofen should be stopped as well.
On the day before surgery, you will receive a phone call alerting you to the time that you should arrive, and you should wash the surgical area with an antibacterial soap. You may be instructed to drink one bottle of magnesium citrate to evacuate the bowels in preparation for the procedure.
You should not eat or drink anything after midnight on the day of surgery, but you may take approved home medications in the morning before surgery with a small sip of water.
What to Expect after Surgery
The surgery typically requires hospitalization for one or two nights. Patients have a catheter draining their bladder that will be left in place upon discharge home. There may be an additional external surgical drain that is usually removed prior to discharge.
Light activity, including walking, under nursing supervision is recommended. The nursing staff will also provide teaching to use a breathing device called an incentive spirometer that helps encourage patients to take deep breaths. Additional teaching will be provided about catheter maintenance and management.
Patients may begin drinking liquids following surgery and can slowly advance to more solid food as tolerated. It is common to have abdominal discomfort and bloating as well as blood-tinged urine.