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Prostatectomy

Procedure overview

A radical prostatectomy removes the prostate and some tissues around it, including the seminal vesicles. The surgeon may also remove lymph nodes from the pelvis (called a pelvic lymph node dissection) at the same time as doing a radical prostatectomy. There are four approaches to removal of the prostate; Retropubic radical prostatectomy, Perineal radical prostatectomy, Laparoscopic radical prostatectomy, and Robotic radical prostatectomy. Surgeons can make a large incision (cut) to reach the prostate (called open surgery). They can also use laparoscopic or robotic techniques, which are done through smaller incisions in the pelvis. These types of surgery are less invasive than a radical prostatectomy.[1]  It is important to understand which procedure is the right procedure for you, and this should be discussed with your provider.

prostatectomy-open-vs-robotic
Figure 1. Open vs Robotic, Port Placement for Prostate Surgery

Robot assisted radical prostatectomy is a minimally invasive technique used to remove the prostate in patients with prostate cancer. During a robotic assisted prostatectomy a surgeon performs the procedure through four to six small incisions spread in a fan shape across the upper abdomen.[2] A three-dimensional endoscope is inserted within one of the incisions providing the surgical team a magnified view of the prostate and the delicate structures surrounding the organ (e.g., nerves, blood vessels and muscles), allowing optimal preservation of these vital structures. The prostate is eventually removed through one of the keyhole incisions.[3] This is much less invasive than a conventional radical retropubic prostatectomy, which involves an abdominal incision that extends from the belly button to the pubic bone.

Learn more about what robotic assisted surgery is and how surgeons use the technology here.

Potential Benefits​

Patients considering surgical treatment for their prostate cancer have common concerns: cure, recovery, urinary continence, and sexual function. Multiple studies have confirmed that robotic assisted surgery is a safe treatment option.[4],[5]

Robotic assisted prostatectomy has also been shown to result in a lower length of stay in hospital, and lower need for blood transfusions.[8]  Results from recent high quality studies suggest that outcomes are equivalent for robotic assisted surgery method when compared to open, or laparoscopic methods.[6],[7],[8],[9] While some other studies have shown improvements for robotic assisted patient outcomes, ongoing research continues to guide development of best practice for this procedure.

Other Potential Benefits May Include:

  • Similar, or sometimes faster, return of erectile function than patients who had open surgery.[4]
  • Similar, or sometimes faster, return of urinary continence than patients who had open within 6 months of surgery.[7]
  • Similar, or fewer complications after surgery compared to patients who had open surgery.[7],[9]
  • Less chance of being readmitted to the hospital after leaving.[4],[6],[7],[8],[9]

Additional Patient Resources

Visit the Canadian Cancer Society for more informational about the disease, diagnosis, treatment options and support available.

Community Groups

Educational Videos

Patient Stories

M. Regis Labeaume, the Mayor of Quebec City, discusses his prostate cancer diagnosis and his positive experience with minimally invasive robot assisted surgery (Francais)

Patient experience with Robot assisted surgery at the Vancouver Prostate Center  

Brett Hart Discusses his experience with Prostate Cancer & Robot assisted surgery

Surgeon and Patient Videos 

Dr. Nathan Perlis on Minimally Invasive Surgery

Dr. Edward Matsumoto describes robot-assisted surgery

Dr. Kevin Zorn discusses robot assisted surgery (Francais)

Dr. Rodney Beau discusses the evolution of robotic surgery

Dr. Peter Black talks about decision making and the radical prostatectomy procedure

Urologist Dr. Andrew Feifer provides information about Credit Valley’s robotic surgery program

An overview of robot assisted surgery featuring urologists at Humber River Hospital 

Dr. Jun Kawakami speaks to patients at Prostate Cancer Canada Network: Calgary Event

St. Joseph’s Hospital London: Reducing length of stay for Prostate patients

Risks & Considerations

Not everyone is a candidate for robotic assisted procedures, and other treatment options may be available and appropriate. Only a doctor can determine whether robotic assisted surgery is appropriate for a patient’s situation. Surgery of any form contains risks and it is important to discuss risks with your provider. Patients and doctors should review all available information on both non-surgical and surgical options in order to make an informed decision.

Patients have also developed support areas where they are able to speak with each other about the surgery, their experiences, and any issues that they have faced during their treatment. To learn more check out the additional resources above or visit the community section of this website.

[1]https://www.cancer.ca/en/cancer-information/cancer-type/prostate/treatment/?region=on

[2] https://www.prostatecentre.com/patient-information/diseases-prostate/prostate-cancer/treatments/prostatectomy

[3] https://www.hopkinsmedicine.org/health/treatment-tests-and-therapies/radical-prostatectomy

[4] Fuller, Andrew, and Stephen E. Pautler. “Complications Following Robot-Assisted Radical Prostatectomy in a Prospective Canadian Cohort of 305 Consecutive Cases.” Canadian Urological Association Journal, vol. 6, no. 2, 2 Mar. 2012, 10.5489/cuaj.11116. Accessed 16 Oct. 2019.

[5] Zakaria, A.S., et al. “Impact of Surgical Wait Times during Summer Months on the Oncological Outcomes Following Robotic-Assisted Radical Prostatectomy: 10 Years’ Experience from a Large Canadian Academic Center.” European Urology Open Science, vol. 19, July 2020, pp. e588–e589, 10.1016/s2666-1683(20)32962-1. Accessed 14 Aug. 2020.

[6] Ilic  D, Evans  SM, Allan  CA, Jung  JH, Murphy  D, Frydenberg  M. Laparoscopic and robotic‐assisted versus open radical prostatectomy for the treatment of localised prostate cancer. Cochrane Database of Systematic Reviews 2017, Issue 9. Art. No.: CD009625. DOI: 10.1002/14651858.CD009625.pub2.

[7] Yaxley, John W, et al. “Robot-Assisted Laparoscopic Prostatectomy versus Open Radical Retropubic Prostatectomy: Early Outcomes from a Randomised Controlled Phase 3 Study.” The Lancet, vol. 388, no. 10049, Sept. 2016, pp. 1057–1066, 10.1016/s0140-6736(16)30592-x. Accessed 14 Aug. 2020.

[8] Coughlin, Geoffrey D, et al. “Robot-Assisted Laparoscopic Prostatectomy versus Open Radical Retropubic Prostatectomy: 24-Month Outcomes from a Randomised Controlled Study.” The Lancet Oncology, vol. 19, no. 8, Aug. 2018, pp. 1051–1060, www.thelancet.com/journals/lanonc/article/PIIS1470-2045(18)30357-7/fulltext, 10.1016/s1470-2045(18)30357-7. Accessed 20 Jan. 2020.

[9] Sooriakumaran, P., et al. “A Meta-Analysis Comparing Positive Surgical Margin and Complication Rates of 110,016 Patients Undergoing Open Retropubic, Laparoscopic, and Robotic-Assisted Radical Prostatectomy.” Journal of Clinical Oncology, vol. 29, no. 7_suppl, 1 Mar. 2011, pp. 103–103, 10.1200/jco.2011.29.7_suppl.103. Accessed 14 Aug. 2020.