For many men, the day of surgery feels like the biggest step in their prostate cancer journey. Not knowing what will happen can add to the nerves. This step-by-step guide follows a typical day of robotic prostatectomy, from arriving at hospital to waking up on the ward. Details vary between hospitals, but the overall pattern is similar.
Before you arrive
You will usually be asked not to eat for around six hours before surgery, and to stop clear drinks a couple of hours before. Some hospitals ask you to take a mild laxative or enema the day before. You will be told which of your usual medicines to take or stop, especially blood thinners. Our preparation checklist covers the weeks before.
Arriving at hospital
On arrival, you will meet several members of the team:
- The nursing team: who check your details, take observations and help you change into a gown and compression stockings.
- The surgeon: who reviews the plan, answers final questions and confirms your consent.
- The anaesthetist: who discusses the anaesthetic and pain relief.
You can ask any remaining questions at this stage.
The anaesthetic
You will walk or be taken to the anaesthetic room. The anaesthetist places a small tube, called a cannula, into a vein in your hand or arm. You will then be given medicine to send you to sleep. Robotic prostatectomy is done under general anaesthetic, so you will be fully asleep and feel nothing during the operation.
Preparing for the operation
Once you are asleep, the team:
- positions you on the operating table, with your legs supported and the table tilted so your head is lower than your feet. This allows the bowel to move away from the pelvis.
- places a catheter into your bladder
- cleans the skin and covers you with sterile drapes
- makes small incisions in the abdomen, usually five or six, each around one centimetre
- gently inflates the abdomen with carbon dioxide gas to create working space
The robotic arms are then brought into position and connected to the instruments. Our guide to how the surgical robot works explains each part.
The operation
The surgeon sits at the console and carries out the operation, while the bedside team assists. The main steps are:
- freeing the prostate from the bladder
- separating the prostate from the rectum behind it
- carefully dealing with the nerves on each side, sparing them where possible
- dividing the urethra below the prostate
- removing lymph nodes, if planned
- placing the prostate in a bag
- joining the bladder to the urethra with stitches over the catheter
The prostate is removed through one of the incisions, which may be slightly enlarged. The operation usually takes around two to three hours.
Waking up
You will wake up in the recovery area, where nurses monitor you closely. It is common to feel drowsy, a little sore and sometimes cold. You may have:
- a catheter draining urine
- a drip in your arm
- sometimes a small drain near one of the incisions
- shoulder tip pain, caused by the gas used during surgery, which settles within a day or two
On the ward
Once you are comfortable, you will move to the ward. You will usually be able to drink and eat light food the same day, and the nurses will help you sit out and walk short distances. Most men go home after one or two nights. Our article on going home with a catheter explains what comes next.
The NHS prostate cancer guide and Prostate Cancer UK both have further information.
Professor Prokar Dasgupta performs robotic prostatectomy at The London Clinic. Our robotic prostatectomy page has more detail. Please contact the clinic to arrange a consultation.