Robot-Assisted Radical Prostatectomy (RARP)
What is robot-assisted radical prostatectomy?
Robot-assisted radical prostatectomy is a minimally invasive operation to remove the prostate gland and surrounding tissues. It is most commonly performed to treat prostate cancer that is confined to the prostate. The procedure uses a robotic surgical system controlled entirely by the surgeon, allowing highly precise instrument movements and excellent visualisation. This approach aims to remove the cancer effectively while preserving urinary control and sexual function whenever possible.
Why is it needed?
RARP may be recommended when prostate cancer is localised to the gland and surgical removal is considered an appropriate treatment. It may also be advised when active surveillance is no longer suitable due to signs of disease progression.
Individuals who are medically fit and seeking a curative option may choose this procedure. In certain cases, RARP may also help relieve urinary obstruction caused by the cancer itself.
What happens during the procedure?
The operation is performed under general anaesthesia. Several small incisions are made in the lower abdomen to allow the insertion of robotic instruments and a high-definition camera.
The surgeon operates from a console, using the robotic system to carry out precise surgical movements to remove the prostate and surrounding tissues. The seminal vesicles, located behind the prostate, are also removed.
Once the prostate is removed, the bladder is reconnected to the urethra to allow normal urine flow. A urinary catheter is left in place to assist healing. The operation typically lasts between two and four hours. Most patients stay in hospital for one to two days.
What are the alternatives?
Alternatives to RARP depend on the stage and behaviour of the cancer. Active surveillance may be suitable for slow-growing, early-stage prostate cancer.
Other treatment options include external beam radiotherapy, brachytherapy, hormone therapy or other surgical approaches such as open or laparoscopic prostatectomy. Treatment choice depends on clinical factors, personal preference and multidisciplinary advice.
Potential risks and after effects
Robot-assisted prostatectomy is generally safe, but temporary effects are common. Mild pain or discomfort is expected and easily managed with medication. Bleeding may occur but rarely requires a transfusion.
Infection of the wound or urinary tract may develop and usually responds to antibiotics. Temporary urinary leakage is common after surgery but usually improves over time. A small percentage of individuals may have longer-term incontinence.
Erectile dysfunction can occur, particularly if nerves cannot be fully preserved, with rates varying according to age and pre-operative function. If lymph nodes are removed, a fluid collection called a lymphocele may occur. Rare complications include blood clots or narrowing at the bladder neck.
After the procedure
Most individuals remain in hospital for one to two days. The urinary catheter usually stays in place for seven to fourteen days to support healing of the join between the bladder and urethra. Mild abdominal discomfort and shoulder pain from gas used during surgery are common for a few days.
Light walking is encouraged to reduce the risk of blood clots. Strenuous activity, heavy lifting and cycling should be avoided for four to six weeks. Drinking plenty of fluids helps keep urine clear. Pelvic floor exercises play an important role in regaining bladder control and are usually started soon after surgery.
Follow-up care
The catheter is removed at a follow-up appointment one to two weeks after surgery. Pathology results from the prostate are reviewed to determine whether all cancer has been removed.
PSA levels are monitored every three to six months to check for recurrence. Ongoing support for recovery of urinary and sexual function may include physiotherapy, medications or referral to specialist services.
Long-term follow-up is recommended to monitor cancer control and overall quality of life.
Prostate Procedures
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