Robot-Assisted Radical Prostatectomy For Prostate Cancer

Consultant Urologist & Robotic Surgeon

Robot-Assisted Radical Prostatectomy

Robot-assisted radical prostatectomy (RARP) is a modern surgical approach used to treat prostate cancer. This procedure involves the use of a robotic system, which allows surgeons to perform the removal of the prostate gland with greater precision and control compared to traditional surgical methods.

The surgery is performed using a robotic console controlled by the surgeon, several robotic arms that manipulate surgical instruments, and a high-definition 3D camera that provides a magnified view of the surgical site.

Treating Prostate Cancer with RARP

RARP is increasingly becoming the preferred method for treating localised prostate cancer due to its minimally invasive nature.

Surgical Goals: The goals of RARP include the complete removal of the prostate gland and any surrounding tissues visibly affected by cancer., while also attempting to preserve the nerves surrounding the prostate.

The surgery also aims to ensure clear margins, which means no cancer cells are left at the edges of the removed tissue, reducing the risk of cancer recurrence.

Technological Components and Operation

The technology behind robot-assisted surgery, particularly for procedures like robot-assisted radical prostatectomy, combines advanced robotics, computer technology, and surgical expertise.

The surgeon’s console is the command centre of the robotic system. It provides the surgeon with a direct and immersive view of the surgical site, enhancing visibility and precision during the operation.

The surgeon uses master controls to translate their hand and finger movements into precise, real-time movements of the surgical instruments on the robotic arms.

The robotic arms perform the actual surgical tasks. Typically, a robotic system includes three or four arms: one holds the camera, and the others manipulate surgical instruments.

These arms replicate the surgeon’s movements but with enhanced precision and a greater range of motion than the human hand.

The surgical instruments used in RARP are miniaturised and explicitly designed for intricate tasks such as cutting, suturing, and tissue manipulation. They are mounted on robotic arms and offer a degree of movement that surpasses traditional surgical tools.

The high-definition 3D camera provides a clear and magnified view of the prostate and surrounding areas, aiding in meticulous dissection and removal of the prostate gland.

The entire robotic system is integrated through sophisticated software that coordinates the movements of the robotic arms with the surgeon’s inputs at the console. This software includes safety features that prevent unintended movements, ensuring the surgical procedure is as safe and effective as possible.

Benefits of RARP

Robot-assisted surgery offers several significant benefits over traditional surgical methods:

Enhanced Precision and Control

The robotic system provides surgeons with enhanced precision and control during the surgery.

Reduced Trauma and Blood Loss

Due to the minimally invasive nature of robot-assisted procedures, patients typically experience less trauma to the body compared to open surgeries. Smaller incisions reduce overall blood loss and decrease the likelihood of needing blood transfusions during surgery.

Lower Risk of Complications

The precision and control afforded by robotic surgery contribute to a lower risk of postoperative complications like infections and pain.

Quicker Recovery and Shorter Hospital Stay

Patients often benefit from a faster recovery time, returning to normal activities sooner than those who undergo traditional surgery. This is partly due to smaller incisions, which heal faster.

Better Cancer Control

The greater precision of robotic systems potentially allows for more effective cancer resections with cleaner margins. This reduces the chances of cancer recurrence and may improve long-term survival rates.

Potential Risks and Complications

While robot-assisted radical prostatectomy offers numerous benefits, it is not without potential risks and complications.

Surgical Risks

Common surgical risks include infections, bleeding, and reactions to anaesthesia. Although these risks are generally lower in robot-assisted procedures, they cannot be eliminated.

Technical Failures

The reliance on advanced technology means mechanical failure or software issues can occur during surgery.

Postoperative Complications

Specific complications related to robot-assisted prostatectomy include urinary incontinence and erectile dysfunction.

Cost Considerations

Robot-assisted surgeries can be more expensive than traditional methods due to the cost of the robotic system and its maintenance.

Long-term Outcomes

The long-term outcomes of robot-assisted radical prostatectomy are generally positive, with many patients achieving effective cancer control.

The precise removal of the prostate gland and affected tissues helps in minimising the likelihood of cancer recurrence. Additionally, the robotic system’s enhanced agility and visualisation capabilities can lead to better preservation of nerve and muscle function, potentially resulting in improved continence and erectile function outcomes.

Dr Png Keng Siang

Consultant Urologist & Robotic Surgeon

Dr Png is a United States fellowship-trained urologist who received his urology specialist board certification from Singapore. He is the first and only urologist in Singapore to be inducted into the Fellow, American College of Surgeons (FACS) after completing a minimally invasive surgery fellowship in the USA at the Indiana University School of Medicine, where he sub-specialised in robotic and laparoscopic surgery for urological cancers.

Joint Committee of Specialist Training Site Accreditor, Urology Residency Program
President of the Robotic Surgery Society of Singapore

Prior To Private Practice:

Director of the Robotic Urological Surgery Fellowship Program, Tan Tock Seng Hospital
Director of the National Healthcare Group Urology Residency Program & Adjunct Assistant Professor, NUS Yong Loo Lin School of Medicine
Member of the American Urological Association, Endourological Society (USA)
Executive Committee of the Singapore Urological Association, 2013 to 2020

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Robot-Assisted Radical Prostatectomy

Frequently Asked
Questions

How much pain is expected after the surgery?

Patients experience less pain with robot-assisted procedures due to smaller incisions. Pain management is typically handled with less potent painkillers compared to those required after open surgery.

When can normal activities be resumed after surgery?

Most patients can resume light activities within a few weeks post-surgery. However, full recovery and return to all normal activities might take up to six weeks, depending on the person’s health conditions.

How often are follow-up visits needed after the procedure?

Follow-up schedules vary, but initially, patients might need to visit their surgeon every few months. Over time, these visits may become less frequent depending on the PSA levels and overall recovery.

Robot-Assisted Radical Prostatectomy For Prostate Cancer