Robotic prostatectomy: advanced techniques for preserving sexual function and accelerating recovery

Prostatectomy is often necessary for patients diagnosed with localised prostate cancer or those with severe benign prostatic hyperplasia unresponsive to other treatments. In recent years, robotic-assisted surgery has revolutionised the field, allowing surgeons to perform prostatectomies with greater precision, fewer complications, and a focus on improving post-operative quality of life. In this article, consultant urological surgeon Mr Denosshan Sri explains how robotic prostatectomies are performed, and how they can be beneficial, particularly in terms of sexual function and recovery time.

Understanding prostatectomy and its indications

A prostatectomy involves the removal of all or part of the prostate gland, most commonly due to prostate cancer. For men with localised prostate cancer — where the disease has not spread beyond the prostate — surgery can be curative. It may also be recommended in some cases of benign prostatic hyperplasia when severe urinary symptoms are unmanageable through less invasive means.

The primary goal of prostatectomy in the context of cancer is complete tumour removal, while simultaneously aiming to preserve urinary continence and sexual function. However, traditional open prostatectomy presents challenges in achieving these goals without significant trade-offs.

What are the risks and complications of traditional prostatectomy?

Traditional (open or laparoscopic) prostatectomy can be associated with a number of post-operative complications. Due to the proximity of the prostate to nerves controlling erection and the bladder, patients often experience retrograde ejaculation (where semen enters the bladder instead of exiting via the urethra), erectile dysfunction, and urinary incontinence. Additionally, the larger incisions and less refined visualisation during open surgery can result in increased blood loss, post-operative pain, and longer hospital stays and recovery periods.

Even when surgery is technically successful, the potential for long-term effects on sexual and urinary function can cause significant distress and impact quality of life.

What is robotic-assisted prostatectomy?

Robotic-assisted radical prostatectomy allows the surgeon to operate through small keyhole incisions with robotic arms that mimic the surgeon’s hand movements. These instruments provide enhanced dexterity, and the system offers a high-definition, three-dimensional view of the surgical field, magnified up to ten times.

The surgeon remains in full control throughout the procedure, using hand and foot controls in a nearby console to manipulate the instruments with unmatched precision. This allows for meticulous dissection of tissue and, crucially, more accurate nerve-sparing techniques, which are critical for preserving sexual function.

Key benefits of robotic prostatectomy

The benefits of robotic prostatectomy are increasingly evident, particularly when performed in high-volume centres by experienced robotic surgeons. These advantages include:

• Improved preservation of urethral sphincter and continence mechanism, resulting in most men achieving continence with pelvic floor physiotherapy post robotic prostatectomy. 
• Improved preservation of the neurovascular bundles, which are responsible for erectile function
• Reduced blood loss and lower risk of needing transfusions
• Smaller incisions, leading to less post-operative pain and a reduced risk of infection
• Shorter hospital stays – often just 24–48 hours
• Faster return to normal activities and quicker overall recovery
• Enhanced ability to achieve cancer control while sparing important surrounding structures
• Of particular significance to many patients is the potential for better preservation of sexual function. With careful nerve-sparing techniques and patient-specific surgical planning, many men regain erections with the help of oral medication or other treatments within months of surgery — outcomes that are less predictable with traditional open methods.

A modern approach to prostate cancer surgery

For men facing a prostate cancer diagnosis, robotic-assisted surgery offers a modern, patient-centred approach that prioritises both oncological outcomes and post-operative quality of life. While not suitable for every case, and not without its own risks, robotic prostatectomy represents a major step forward in prostate cancer management.

With the right counselling and in the hands of an experienced robotic surgeon, patients can make informed choices that align with their values and priorities, including the preservation of sexual function and minimising disruption to daily life. As technology continues to evolve, so too do the possibilities for safer, more effective, and more compassionate surgical care.