Treatment guide
Robotic Prostatectomy
Also known as: Robot-assisted radical prostatectomy, RARP, Robot-assisted laparoscopic prostatectomy, da Vinci prostatectomy
In brief
Robotic prostatectomy (robot-assisted radical prostatectomy) is keyhole surgery to remove the whole prostate gland for prostate cancer. The surgeon controls precise robotic instruments through several small incisions, aiming to remove the cancer while preserving urinary control and, where safe, the nerves responsible for erections.
Medically reviewed by Dr. Atip Chatsudthipong, MD on
Written by Editorial teamPublished Updated
What is robotic prostatectomy?
A radical prostatectomy removes the entire prostate gland and the seminal vesicles — and, when indicated, nearby lymph nodes — to treat prostate cancer. In a robotic prostatectomy, the surgeon sits at a console and controls instruments that are inserted through small incisions in the abdomen, viewing the operation through a magnified, three-dimensional camera.
The robotic system translates the surgeon's hand movements into very fine, steady movements inside the body. It does not operate on its own: every step is performed by the surgeon.
Who may be suitable?
- Men with localised prostate cancer — usually intermediate- or high-risk disease — for whom curative treatment is recommended
- Men in good general health with a life expectancy that makes curative treatment worthwhile
- Selected men with locally advanced cancer, sometimes as part of combined treatment
Many low-risk cancers are better managed with active surveillance, and radiation therapy is an equally valid curative option for many men. Guidelines from the AUA and EAU recommend that the choice be made together after discussing the benefits and side effects of each approach — ideally with input from both a urologist and a radiation oncologist.
How is the surgery performed?
- You receive a general anaesthetic.
- Several small incisions are made in the abdomen for the camera and robotic instruments.
- The prostate and seminal vesicles are carefully separated from surrounding structures. Where it is safe for cancer control, the nerves that control erections are preserved (nerve-sparing surgery).
- Pelvic lymph nodes are removed when the cancer's risk profile suggests it.
- The bladder is reconnected to the urethra, and a urinary catheter is left in place while this join heals.
- The prostate is removed through one of the incisions and sent for detailed pathology.
The operation usually takes a few hours, and most men stay in hospital for one to two nights.
How should I prepare?
- Review of your biopsy, MRI and any staging scans, and a pre-operative anaesthetic assessment
- Instructions on stopping blood thinners and other medicines
- Starting pelvic floor muscle exercises before surgery, which may help urinary control recover sooner
- For international patients: planning to stay in Bangkok until your catheter has been removed and you have been reviewed
What are the potential benefits of the robotic approach?
Compared with traditional open surgery, robot-assisted surgery generally involves less blood loss, smaller incisions, less pain and a shorter hospital stay. A randomised trial comparing robotic and open prostatectomy found similar urinary and sexual function outcomes at two years — so the experience of the surgeon matters more than the technology alone.
What are the side effects and risks?
| Effect | What to expect |
|---|---|
| Urinary leakage | Common at first after the catheter is removed. Most men regain good control over weeks to months; a minority have persistent leakage, for which further treatment is available. |
| Erectile dysfunction | Common initially. Recovery depends on age, pre-operative function and whether nerves could be spared, and may continue for up to two years. Treatments and rehabilitation can help. |
| Fertility and ejaculation | Orgasm remains possible but no semen is produced, so natural conception is no longer possible. |
| Surgical risks | Bleeding, infection, blood clots, hernia at an incision, narrowing where the bladder joins the urethra, and rarely injury to nearby organs. |
What are the alternatives?
Depending on the cancer's risk group, alternatives include active surveillance, external beam radiotherapy or brachytherapy (with or without hormone therapy), and, in selected situations, focal therapies. See Prostate cancer for an overview.
What is recovery like after robotic prostatectomy?
- Walking is encouraged from the day after surgery
- The catheter is usually removed after about one to two weeks
- Most men return to desk-based work within a few weeks; heavy lifting is avoided for around six weeks
- The PSA level is checked regularly after surgery — it is expected to fall to an undetectable level
- The pathology report guides whether any further treatment is needed
Contact the hospital urgently if you develop:
- Fever or chills
- Increasing abdominal pain or swelling
- A blocked or dislodged catheter
- Calf pain or swelling, or shortness of breath
Robotic prostatectomy with Dr. Atip
Dr. Atip performs robot-assisted radical prostatectomy at Bumrungrad International Hospital. Prostate cancer is one of his principal clinical interests: he will review your PSA, MRI and biopsy findings, explain whether surgery, radiation or active surveillance best suits your situation, and guide you through recovery — including continence and erectile rehabilitation.
Frequently asked questions
Is robotic prostatectomy better than open surgery?
Robotic surgery usually means less blood loss, smaller incisions and a shorter hospital stay. A randomised trial found similar urinary and sexual function at two years compared with open surgery, so the surgeon's experience is the most important factor.
How long will I need a catheter after robotic prostatectomy?
Usually for about one to two weeks, while the join between the bladder and urethra heals. Your surgeon will confirm the timing.
Will I be incontinent after prostate surgery?
Some leakage is common at first. Most men regain good urinary control over weeks to months, helped by pelvic floor exercises. A small proportion have persistent leakage, for which effective treatments exist.
How long should international patients stay in Bangkok after surgery?
Plan to stay until your catheter has been removed and you have been reviewed after surgery. Your surgeon will advise on the timing for your situation before you book flights.
References
- 1.Eastham JA, et al. Clinically Localized Prostate Cancer: AUA/ASTRO Guideline, Part I — Introduction, Risk Assessment, Staging, and Risk-Based Management. J Urol. 2022;208(1):10–18. (opens in a new tab)
- 2.European Association of Urology. EAU – EANM – ESTRO – ESUR – ISUP – SIOG Guidelines on Prostate Cancer. (opens in a new tab)
- 3.Yaxley JW, et al. Robot-assisted laparoscopic prostatectomy versus open radical retropubic prostatectomy: early outcomes from a randomised controlled phase 3 study. Lancet. 2016;388(10049):1057–1066. (opens in a new tab)
- 4.Coughlin GD, et al. Robot-assisted laparoscopic prostatectomy versus open radical retropubic prostatectomy: 24-month outcomes from a randomised controlled study. Lancet Oncol. 2018;19(8):1051–1060. (opens in a new tab)
- 5.National Cancer Institute. Prostate Cancer Treatment (PDQ®) — Patient Version. (opens in a new tab)
This information is for general education and does not replace a consultation with a qualified doctor. If you have severe symptoms, seek emergency care (in Thailand, call 1669). See our medical disclaimer.