Prostate Cancer

Robot-assisted laparoscopic radical prostatectomy

Robot-assisted laparoscopic radical prostatectomy is a modern technique for treating localised prostate cancer. Few centres in the UK offer this procedure but many are training to do so. In the UK in 2012 29% of radical prostatectomies were robot assisted*1.

Laparoscopic surgery; also known as keyhole surgery, uses instruments inserted through narrow hollow tubes ('ports') rather than through a larger incision, as in traditional surgery. This type of surgery has the potential for shorter hospitalisation and convalescence, less bleeding and post-operative pain, and fewer wound complications, but randomised trials are still needed to assess outcomes.

The first robotic-assisted radical prostatectomy was performed in 2000. In 2007 we talked to a 48-year-old man, Mike,  three months after he had had this new treatment in the National Health Service and in 2010 we talked to another man, John, a year after he had this type of surgery.

Between 2005 and 2006 Mike had had some urinary symptoms, had a raised PSA (about 12 ng per ml.), was referred to a consultant and had a prostate biopsy. During the biopsy and other investigations his privacy and dignity were not always respected (see 'Biopsy').

Having been given the diagnosis of prostate cancer he found out about different treatment options and decided which would suit him best.  After having urinary symptoms for some time John was also diagnosed with prostate cancer. He explained why he decided to have a robot assisted laparoscopic radical prostatectomy and not brachytherapy or any other type of treatment.

Mike and John both talked about pre-operative care, their operations, post-operative recovery and the side effects of surgery.

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Mike was in hospital for three days. On the first day he had more investigations and was seen by various doctors, including the anaesthetist, and by a specialist urology nurse. He had prepared for the procedure by doing pelvic floor exercises for 2-3 weeks pre-operatively.

A catheter was inserted during the operation, and a drain attached to a tube on one side of the abdomen. On the first post-operative day Mike got out of bed unaided and could go home that afternoon.

Long-term data about urinary continence and erectile function after surgery are not yet available, but studies presenting data at follow up longer than 12 months have reported continence rates of between 84% and 98%. Mike had his catheter removed after 10 days. He stayed one night in hospital after the catheter had been removed and was pleased to find that he was not incontinent. He was glad that he had done the pelvic floor exercises before his operation. 

Men who suffer from incontinence have various options, including special pelvic floor exercises, pads, catheters, medical therapies and surgical intervention. Surgery includes the ‘male sling’ and the artificial urinary sphincter. Surgical intervention is usually considered 1-2 years after prostatectomy (see Welk and Herschorn 2010) (also see our summary 'Urinary incontinence').  
 

Available 12-month follow-up data suggest that between 20% and 97% of men can have sexual intercourse after nerve sparing robot-assisted laparoscopic prostatectomy. The surgical technique and the patient's age can influence these results. 

Mike was glad he had chosen this type of treatment. Three months after surgery his PSA reading was 0.1ng per ml. He will continue to have regular check-ups. John was also glad that he had had this operation. He believes that he had exactly the right treatment.

It is important to note that this is only based on two men's experiences of robot-assisted laparoscopic radical prostatectomy. 

Laparoscopic and robot-assisted prostatectomy are seen as more expensive then open surgery because of the expense of the equipment and it is normally only offered in specialised cancer centres with specially trained clinicians. National Institute for Health and Care Excellence (NICE) guidelines 2014 (CG175) states “Commissioners should ensure that robotic systems for the surgical treatment of localised prostate cancer are cost effective by basing them in centres that are expected to perform at least 150 robot-assisted laparoscopic radical prostatectomies per year".

*1 Comparative Cost-effectiveness of Robot-assisted and Standard Laparoscopic Prostatectomy as Alternatives to Open Radical Prostatectomy for Treatment of Men with Localised Prostate Cancer: A Health Technology Assessment from the Perspective of the UK National Health Service. By: Andrew Closea, Clare Robertsonb, Stephen Rushtona, Mark Shirleya, Luke Valec, Craig Ramsayb and Robert Pickardd, European Urology, Volume 64 Issue 1, September 2013, Pages 361-369

*2 See article by V. Ficarra and colleagues called “Systematic Review and Meta-analysis of Studies Reporting Urinary Continence Recovery After Robot-assisted Radical Prostatectomy” found in European Urology 2012, volume 62, pages 405-417

*3 Also see an article by Blayne Welk and Sender Herschorn called “Are male slings for post-prostatectomy incontinence a valid option?” which can be found in Current Opinion in Urology 2010, volume 20, pages 465-470.

*4 For more information see an article by V. Ficarra and colleagues called “Evidence from Robot-Assisted Laparoscopic Radical Prostatectomy' A Systematic Review”, which can be found in European Urology 2007, volume 51, pages 45-56. 

 

Last reviewed March 2015.

Last updated March 2015.

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