Robotic-assisted radical prostatectomy (RARP)

What is involved in the Robotic-assisted radical prostatectomy procedure?

Radical prostatectomy is a surgical procedure aimed at removing the entire prostate gland, seminal vesicles, and surrounding tissues. Typically used to treat localized prostate cancer, this intervention can be performed traditionally or robotically using minimally invasive techniques. The surgery aims to eliminate cancerous cells and potentially cure the disease, especially in cases where the cancer has not spread beyond the prostate. Potential side effects include urinary incontinence and erectile dysfunction, though advancements in surgical techniques aim to minimize these complications. Patient selection for radical prostatectomy involves considering factors such as cancer stage, patient age, and overall health. Post-surgery, regular follow-ups, and monitoring are essential to assess the treatment's effectiveness and address any lingering issues. As with any medical intervention, the decision to undergo radical prostatectomy should be made collaboratively between the patient and the healthcare team, considering the potential benefits and risks.

Robotic prostatectomy is the most utilised form of prostate cancer treatment in Melbourne


surgery main points

Key Points:

Complete removal of the prostate and seminal vesicles is the goal of this procedure.

  • Utilization of small robotic instruments for precise surgery

  • "Keyhole" incisions made in the lower abdomen for the procedure

  • The surgeon maintains full control over instruments, with the robot mimicking and assisting movements

  • Aims for cancer confined to the prostate include complete removal, achieving clear margins, lowering PSA levels, reducing the need for further treatment, and preserving continence and erection nerves if possible.

  • Robotic surgery offers high precision and faster recovery compared to open surgery, using mini-instruments controlled by the surgeon.

  • Surgeons aim to preserve muscles and nerves controlling continence, addressing postoperative urine leakage if necessary with corrective procedures.

  • Preservation of erection nerves is attempted through nerve-sparing prostatectomy, which can be successful in maintaining erections after recovery.

  • The team provides guidance on maintaining a healthy sex life after surgery, even if nerves do not fully recover or need removal.

  • Potential side effects include erectile dysfunction (impotence), urine leakage, and shortening of the penis

surgery

What occurs on the day of the procedure?

A/Prof Homi Zargar will discuss the surgery once again to ensure your understanding and obtain your consent. An anaesthetist will meet with you to explore the options of a general or spinal anaesthetic and discuss post-procedure pain relief.

Details of the procedure:

  • Procedure performed under general anesthesia

  • Antibiotic injection administered before the procedure, with careful allergy check

  • Five or six keyhole incisions made in the abdomen for robotic instrument insertion

  • Robotic instruments used to free the prostate from the bladder and urethra, preserving muscles and nerves for continence and erection

  • Urethra rejoined to the bladder using absorbable stitches

  • Local anesthesia applied to numb keyhole incisions, minimizing postoperative discomfort

  • Closure of all keyhole incisions with absorbable stitches

  • Catheter inserted in the bladder to drain urine during healing of the bladder-urethra join

  • Procedure typically takes two to three hours

  • Postoperative effects may include bruising and swelling around keyhole incisions, scrotal puffiness, facial puffiness, shoulder pain, and bloating; patients can usually go home after a day or two.

After-Effects and Risks of the Procedure:

  • No semen production during orgasm, resulting in infertility for all patients

  • High likelihood of erectile dysfunction (impotence) if nerve-sparing is not possible, potentially causing some shortening of the penis

  • Mild urinary incontinence is expected in almost all patients after catheter removal (80 to 85%)

  • Between 1 in 5 and 1 in 10 patients may experience persistent mild urinary incontinence, requiring safety pads but not corrective surgery

  • Severe urinary incontinence, possibly temporary but may require further surgery, occurs between 1 in 20 and 1 in 33 patients (3 to 5%)

  • Positive margins in pathology tests may indicate cancer outside or at the margin of the prostate, requiring observation and potential further treatment in 1 in 10 to 1 in 50 patients

  • Further treatment such as hormones, radiotherapy, or chemotherapy may be needed if PSA blood test indicates persistent cancer in 1 in 10 to 1 in 50 patients

  • Leakage of urine from the new joint between bladder and urethra, potentially delaying discharge or requiring extended catheter time, occurs in 1 in 10 to 1 in 50 patients

  • Bleeding necessitating transfusion or further surgery is observed in 1 in 10 to 1 in 50 patients

  • Pain, infection, or hernia in any of the port incisions may require additional treatment in 1 in 10 to 1 in 50 patients

  • Lymph fluid collection, particularly if pelvic lymph nodes were removed or biopsied during surgery, occurs in 1 in 10 to 1 in 50 patients

  • Anaesthetic or cardiovascular problems, possibly requiring intensive care admission, have a frequency of 1 in 50 to 1 in 250 patients (individual risk estimate available from the anaesthetist)

  • Conversion to open surgery due to operative difficulty or failure to progress is needed in 1 in 100 patients (1%)

  • Eye problems, numbness, and weakness from nerve compression during surgery's "head-down" position may occur in 1 in 50 to 1 in 250 patients

  • Recognized or unrecognized injury to the bowel, small or large, may require a temporary colostomy for healing in 1 in 200 to 1 in 250 patients.