Prostatectomy (Open and Robotic)

A radical prostatectomy is the removal of the entire prostate and seminal vesicles to treat prostate cancer. In certain cases the pelvic lymph nodes will also be removed. The prostate is a male sexual organ that makes the majority of the ejaculate volume for reproduction. It is situated between the bladder and urethra and sits on top of the rectum. The procedure is performed under anesthesia and typically takes 2-4 hours.

For a traditional open retropubic prostatectomy a 3-5 inch incision is made in the abdominal midline below the belly button. The skin and fascia is incised to expose the prostate and bladder. The prostate is surgically removed and the bladder and urethra are sewn together (anastamosis). The nerves responsible for erections and urinary control run alongside the prostate.  A nerve sparing technique to preserve sexual function is performed in the majority of cases. Blood loss and hospital stays are slightly higher with the traditional open approach. One will typically be in the hospital for 2-3 days.

For a robotic-assisted prostatectomy, a 1 inch incision is made above or below the belly button. The abdominal cavity is filled with carbon dioxide gas and a magnified 3-D camera is introduced. Five additional ½ inch incisions are made in the lower abdomen and special ports are placed into the abdomen to perform the surgery using small instruments with 360 degree range of motion. The daVinci robot is then docked and the surgeon uses specially controlled arms to perform the operation under magnification and being able to see three dimensionally with the special camera.  Following prostate removal, the bladder and urethra are sewn together (an anastamosis). The nerves responsible for erections and urinary control run alongside the prostate, and a nerve sparing procedure is performed in the majority of cases. Blood loss and hospital stay are typically less with a robotic prostatectomy and you will be released from the hospital 1-2 days after your surgery.

What to expect afterwards:

A catheter and possibly a surgical drain are placed at the time of surgery. The drain is usually removed the day after surgery. You will be sent home with the catheter and the hospital will provide you with a drainage bag that can be strapped to your leg. The catheter will remain in for 7-14 days following surgery. It is important that it remain in place during this time to facilitate proper healing of the anastamosis of the urethra to the bladder. No one should manipulate or remove the catheter without first discussing this with your urologist. In certain circumstances you will undergo an X-ray study prior to your follow-up appointment to evaluate the anastamosis, before the catheter is removed.

For both procedures you will have skin staples, dissolvable sutures, or “skin glue” over the incisions. It is normal to have redness, bruising, and some drainage from the incisions.

For more detailed information regarding prostate cancer and surgery visit our page on DaVinci prostatectomy.