Prostate Surgery

Learn about prostate surgery and understand your options

Get back to what matters most

If you’ve been told you have prostate cancer, know that there are more than 2.9 million men living in the U.S. who have been diagnosed with prostate cancer.¹ Prostate cancer is the second most common cancer among American men, affecting about one in nine.¹ 

Prostate cancer can be found before you even have symptoms with screening, such as testing the amount of prostate-specific antigen (PSA) in your blood or a digital rectal exam (DRE) to feel the prostate gland.²

If you have recently received a prostate cancer diagnosis, you and your doctor can decide on the course of action that makes sense to you based on factors that include the size of the tumor and whether the cancer is likely to have spread, along with other factors like your age, health, and other personal considerations.

Understanding your options

Available options for care include watchful waiting (observation) or active surveillance, where you note changes in symptoms and monitoring results of exams and blood tests. This is used because prostate cancer often grows very slowly and some men might never need treatment for their prostate cancer.³ 

There are many active therapy options available to men today, including chemotherapy, hormone therapy, cryotherapy, and radiation.⁴ It is possible that your doctor will recommend a radical prostatectomy, which is surgery to remove your prostate gland and nearby tissue, as well as lymph nodes that will be tested to see if the cancer has spread beyond the prostate gland.

Surgeons can perform a radical prostatectomy through open surgery, which requires a large incision in your abdomen, or a minimally invasive approach. In traditional open surgery, the surgeon looks directly at the surgical area through the incision and removes the prostate gland using hand-held tools. 

There are two minimally invasive approaches: laparoscopic prostatectomy and robotic-assisted surgery, possibly with da Vinci® technology. Surgeons perform minimally invasive laparoscopic or robotic-assisted surgeries through a few small incisions or a single small incision. To perform a laparoscopic prostatectomy, surgeons use special long-handled tools while viewing magnified images from the laparoscope (camera) on a video screen.

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How da Vinci works

Surgeons using da Vinci technology may be able to remove your prostate gland through a few small incisions (cuts) or one small incision. During surgery, your surgeon sits at a console next to you and operates using tiny instruments. 

A camera provides a high-definition, 3D magnified view inside your body. The da Vinci system translates every hand movement your surgeon makes in real time to bend and rotate the instruments with precision.

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It’s important to remember that Intuitive does not provide medical advice. After discussing all options with your doctor, only you and your doctor can determine whether surgery with da Vinci is appropriate for your situation. You should always ask your surgeon about his or her training, experience, and patient outcomes.

Why surgery with da Vinci?

A review of published studies suggest that potential benefits of a radical prostatectomy with da Vinci technology include:

• Patients may experience similar, or sometimes faster, return of erectile function than patients who had open.^5-9
• Patients may experience similar, or sometimes faster, return of urinary continence than patients who had open within 6 months of surgery.^5-9 
• When compared to patients who had open surgery, patients undergoing surgery with da Vinci may have less chance of being readmitted to the hospital after leaving.^9-12 
• Patients may experience similar or fewer complications after surgery compared to patients who had open surgery.^5-7,9-21
• Patients may stay in the hospital for a shorter amount of time than patients who had open surgery.^{5,6,8-11,13-16,18-27}

All surgery involves risk. Read more about associated risks of prostatectomy.

Questions you can ask your doctor

• What medical and surgical options are available for me?
• Which is best for my situation?
• What are the differences between open, laparoscopic, and robotic-assisted surgery?
• Can you tell me about your training, experience, and patient outcomes with da Vinci?
• What am I likely to experience after surgery?

More about urologic surgery with da Vinci

Robotic-assisted surgery with da Vinci technology is used in many different types of procedures by urology surgeons.

About the specialty

 

^{1. Key Statistics for Prostate Cancer. American Cancer Society. Web. 17 January 2019} 

^{2. Can Prostate Cancer Be Found Early? American Cancer Society. Web. 18 January 2019}

^{3. Watchful Waiting or Active Surveillance for Prostate Cancer. American Cancer Society. Web. 18 January 2019.} 

^{4. Treating Prostate Cancer. American Cancer Society. Web. 21 January 2019}

^{5. De Carlo, F., F. Celestino, et al., Retropubic, Laparoscopic, and Robot-Assisted Radical Prostatectomy: Surgical, Oncological, and Functional Outcomes: A Systematic Review. Urol Int, 2014.}

^{6. Moran, P.S., M. O'Neill, et al., Robot-assisted radical prostatectomy compared with open and laparoscopic approaches: A systematic review and meta-analysis. Int J Urol, 2013. 20(3): p. 312-21.}

^{7. Pan, X.W., X.M. Cui, et al., Robot-Assisted Radical Prostatectomy vs. Open Retropubic Radical Prostatectomy for Prostate Cancer: A Systematic Review and Meta-analysis. Indian Journal of Surgery, 2014.}

^{8. Seo, H.J., N.R. Lee, et al., Comparison of robot-assisted radical prostatectomy and open radical prostatectomy outcomes: A systematic review and meta-analysis. Yonsei Medical Journal, 2016. 57(5): p. 1165-1177.}

^{9. Yaxley, J.W., G.D. Coughlin, et al., Robot-assisted laparoscopic prostatectomy versus open radical retropubic prostatectomy: early outcomes from a randomised controlled phase 3 study. Lancet, 2016}

^{10. Tewari, A., P. Sooriakumaran, et al., Positive Surgical Margin and Perioperative Complication Rates of Primary Surgical Treatments for Prostate Cancer: A Systematic Review and Meta-Analysis Comparing Retropubic, Laparoscopic, and Robotic Prostatectomy. European Urology, 2012. 62(1): p. 1-15.} 

^{11. Gandaglia, G., J.D. Sammon, et al., Comparative Effectiveness of Robot-Assisted and Open Radical Prostatectomy in the Postdissemination Era. J Clin Oncol, 2014.}

^{12. Pilecki, M.A., B.B. McGuire, et al., National multi-institutional comparison of 30-day post-operative complication and re-admission rates between open retropubic radical prostatectomy (RRP) and robot-assisted laparoscopic prostatectomy (RALRP) using NSQIP. J Endourol, 2013.}

^{13. Laird, A., S. Fowler, et al., Contemporary practice and technique-related outcomes for radical prostatectomy in the UK: A report of national outcomes. BJU International, 2015. 115(5): p. 753-763.}

^{14. Novara, G., V. Ficarra, et al., Systematic Review and Meta-analysis of Perioperative Outcomes and Complications After Robot-assisted Radical Prostatectomy. European Urology, 2012.}

^{15. Davis, J., U. Kreaden, et al., Learning Curve Assessment of Robot-Assisted Radical Prostatectomy Compared to Open Surgery Controls from the Premier Perspective Database. J Endourol, 2013.}

^{16. Ellimoottil, C., F. Roghmann, et al., Open versus robotic radical prostatectomy in obese men. Current Urology, 2015. 8: p. 156-161.}

^{17. Stolzenburg, J.U., I. Kyriazis, et al., National trends and differences in morbidity among surgical approaches for radical prostatectomy in Germany. World J Urol, 2016.}

^{18. Sugihara, T., H. Yasunaga, et al., Robot-assisted versus other types of radical prostatectomy: Population-based safety and cost comparison in Japan, 2012-2013. Cancer Science, 2014. 105(11): p. 1421-1426.}

^{19. Trinh, Q.D., J. Sammon, et al., Perioperative Outcomes of Robot-Assisted Prostatectomy Compared With Open Radical Prostatectomy: Results From the Nationwide Inpatient Sample. European Urology, 2012. 61(4): p. 679-85.}

^{20. Yu, H.Y., N.D. Hevelone, et al., Hospital volume, utilization, costs and outcomes of robot-assisted laparoscopic radical prostatectomy. J Urol, 2012. 187(5): p. 1632-7.}

^{21. Kim, S.P.S., N. D.; Karnes, R. J.; Weight, C. J.; Shippee, N. D.; Han, L. C.; Boorjian, S. A.; Smaldone, M. C.; Frank, I.; Gettman, M. T.; Tollefson, M. K.; Thompson, R. H., Hospitalization Costs for Radical Prostatectomy Attributable to Robotic Surgery. European Urology, 2012.}

^{22. Pearce, S.M., J.J. Pariser, et al., Comparison of Perioperative and Early Oncologic Outcomes Between Open and Robotic-Assisted Laparoscopic Prostatectomy in a Contemporary Population-Based Cohort. J Urol, 2016.}

^{23. Basto, M., N. Sathianathan, et al., A patterns of care and health economic analysis of robotic radical prostatectomy in the Australian public health system. BJU Int, 2015.}

^{24. Wen, T., C.M. Deibert, et al., Positioning-related complications of minimally invasive radical prostatectomies. Journal of Endourology, 2014. 28(6): p. 660-667.}

^{25. Monn, M.F., K.R. Jaqua, et al., Impact of Obesity on Wound Complications Following Radical Prostatectomy is Mitigated by Robotic Technique. Journal of Endourology, 2016. 30(8): p. 890-895.}

^{26. Anderson, J.E., D.C. Chang, et al., The first national examination of outcomes and trends in robotic surgery in the United States. J Am Coll Surg, 2012. 215(1): p. 107-14; discussion 114-6.}

^{27. Hyams, E.S., J.K. Mullins, et al., Impact of robotic technique and surgical volume on the cost of radical prostatectomy. Journal of Endourology, 2013. 27(3): p. 298-303.}

Disclosures and Important Safety Information

Surgical Risks

Risks associated with radical prostatectomy (removal of prostate gland and some surrounding tissue) include leaking of urine, urgent need to urinate, cannot get or keep an erection, rectal or bowel injury, narrowing of the urethra, pooling of lymph fluid in the pelvic area or legs.

Important Safety Information

Patients should talk to their doctor to decide if da Vinci® Surgery is right for them. Patients and doctors should review all available information on non-surgical and surgical options and associated risks in order to make an informed decision. 

Serious complications may occur in any surgery, including da Vinci Surgery, up to and including death. Serious risks include, but are not limited to, injury to tissues and organs and conversion to other surgical techniques which could result in a longer operative time and/or increased complications. For Important Safety Information, including surgical risks, indications, and considerations and contraindications for use, please also refer to www.intuitive.com/safety.

Individuals' outcomes may depend on a number of factors, including but not limited to patient characteristics, disease characteristics and/or surgeon experience.

da Vinci Xi® System Precaution Statement

The demonstration of safety and effectiveness for the specific procedure(s) discussed in this material was based on evaluation of the device as a surgical tool and did not include evaluation of outcomes related to the treatment of cancer (overall survival, disease-free survival, local recurrence) or treatment of the patient’s underlying disease/condition. Device usage in all surgical procedures should be guided by the clinical judgment of an adequately trained surgeon.

Medical Advice and Locating a Doctor

Patients should talk to their doctor to decide if da Vinci Surgery is right for them. Other options may be available and appropriate. Only a doctor can determine whether da Vinci Surgery is appropriate for a patient’s situation. Patients and doctors should review all available information on both non-surgical and surgical options in order to make an informed decision.

Surgeons experienced with the da Vinci System can be found using the Surgeon Locator. Intuitive Surgical provides surgeons training on the use of the da Vinci System but does not certify, credential or qualify the surgeons listed in the Surgeon Locator.

Published Evidence

In order to provide benefit and risk information, Intuitive Surgical reviews the highest available level of evidence on procedures named above. Intuitive Surgical strives to provide a complete, fair and balanced view of the clinical literature. However, our materials should not be seen as a substitute for a comprehensive literature review for inclusion of all potential outcomes. We encourage patients and physicians to review the original publicatons and all available literature in order to make an informed decision. Clinical studies are typically available at pubmed.gov.

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