How is a robot-assisted laparoscopic prostatectomy performed?

Marc B. Garnick, MD
Hematology & Oncology
To perform a robot-assisted laparoscopic prostatectomy, the surgeon sits at a console several feet away from the operating table and manipulates robotic arms fitted with tiny cameras and surgical instruments to locate and remove the diseased prostate gland. The console contains two full-color computer screens that provide a magnified, three-dimensional view of the prostate and surrounding tissues. The surgeon guides the robotic arms by manipulating the controls while watching the screens.

A few surgeons practice the perineal technique, arguing that it causes less pain. The disadvantage to this approach is that it doesn't permit access to the pelvic lymph nodes.

Before taking out the prostate -- except in the case of the perineal technique -- the surgeon may remove lymph nodes that he or she suspects may have been infiltrated by the cancer. A pathologist will immediately examine the nodes. If cancer is present, the operation will go no further because this means the cancer has spread beyond the prostate, in which case other treatments are more effective than removing the prostate.

If the lymph nodes show no cancer, the surgeon carefully separates the prostate and the seminal vesicles from the surrounding tissues and removes them. Later, the pathologist examines these organs. If the cancer is confined to the prostate, odds are good that the cancer won't return. If the cancer has already spread beyond the capsule surrounding the gland, additional treatment may be necessary. Recovery usually involves two to three days in the hospital and several weeks at home. The patient will need to urinate through a catheter for a week or two while the urethra heals.

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