General comparisons of robotic and open prostate surgery are a useful starting point. When it comes to your own operation, though, the choice between robotic or open prostatectomy depends on your circumstances as much as on the wider evidence. This article looks at the personal factors that shape the decision and the questions that can help you reach it.
A brief reminder of the differences
Both operations remove the whole prostate to treat localised cancer. Open surgery uses a single larger incision in the lower abdomen. Robotic surgery uses several small incisions, with the surgeon controlling fine instruments from a console and viewing a magnified 3D image. Robotic surgery usually means less blood loss, less pain and a shorter hospital stay. Our comparison of the key differences explains these in more detail.
Factors that shape the choice for you
Previous operations
Earlier surgery in the abdomen or pelvis can cause scar tissue. This does not usually rule out robotic surgery, but it can make the operation more complex. Your surgeon will take it into account when recommending an approach, so it helps to bring details of any previous operations to your consultation.
General health
Robotic surgery requires the patient to be tilted head-down for some time during the operation. For most men this is not a problem, but certain heart, lung or eye conditions may need careful assessment. Your anaesthetist will review this at your pre-operative assessment.
The cancer itself
The size and position of the cancer, and whether it may have spread to lymph nodes, affect how the operation is planned. Both approaches can remove nearby lymph nodes when needed, and your scans help the team decide in advance whether this is likely to be necessary.
Your priorities for recovery
If returning quickly to work, caring responsibilities or travel matters to you, the shorter hospital stay and faster recovery after robotic surgery may be particularly relevant. Our recovery timeline shows what the weeks after robotic surgery usually involve.
Continence and sexual function
Both approaches can preserve the nerves that control erections where it is safe to do so. The skill and experience of the surgeon matter greatly here. Our article on nerve-sparing techniques explains why.
Surgeon expertise
The best approach is often the one your surgeon performs most often and most successfully. A surgeon experienced in robotic surgery will usually recommend it for suitable patients, while being open about any reasons it may not suit you.
What the evidence says
Large studies show that both approaches can achieve effective cancer control. Robotic surgery is consistently associated with less blood loss and a shorter stay in hospital. For longer-term continence and sexual function, the surgeon's experience appears to matter at least as much as the method. Cancer Research UK and the NHS provide independent summaries of the treatment options.
Questions to help you decide
- Which approach do you recommend for me, and why?
- Does anything in my history make one approach more suitable?
- How many of each operation do you perform?
- What are your continence and erectile function results?
- What would recovery look like for me with each approach?
Reaching a decision
For most men with localised prostate cancer who are suitable for surgery, robotic prostatectomy offers a more comfortable recovery with equally effective cancer control. Even so, the right choice is always an individual one, made with a specialist who understands your diagnosis and priorities.
Professor Dasgupta has many years of experience in robotic surgery and has helped develop the technique in the UK. Our robotic prostatectomy page describes the operation he performs. To discuss which approach would suit you, please contact the clinic.