When surgery is recommended for prostate cancer, one of the most common questions is whether it should be robotic or open. Both operations remove the whole prostate, and both aim to cure the cancer. The differences lie mainly in how the operation is performed and what recovery feels like. This side-by-side comparison of robotic vs open prostate surgery explains what each involves.
How each operation is performed
Open surgery
Open radical prostatectomy is the traditional approach. The surgeon makes a single larger incision in the lower abdomen and removes the prostate directly, using their hands and conventional instruments.
Robotic surgery
Robotic-assisted radical prostatectomy is a form of keyhole surgery. The surgeon makes several small incisions and controls fine instruments from a console, viewing a magnified, high-definition 3D image. Every movement is made by the surgeon; the robot translates those movements with great precision. A bedside assistant and the theatre team support the operation throughout. Our guide to what robotic surgery is explains the technology in more detail.
Comparing the patient experience
- Incisions: one larger cut for open surgery; several small cuts for robotic surgery.
- Blood loss: generally lower with robotic surgery, so transfusions are rarely needed.
- Pain: usually less after robotic surgery, because the incisions are smaller.
- Hospital stay: often one to two days after robotic surgery; usually longer after open surgery.
- Return to normal activity: generally faster after robotic surgery.
Our recovery timeline sets out what the weeks after robotic surgery typically involve.
Precision and visibility
One of the main advantages of robotic surgery is the view. Magnified 3D imaging lets the surgeon see the nerves, blood vessels and other structures around the prostate clearly. Combined with steady, precise instruments, this supports careful nerve-sparing where it is safe to do so.
Cancer control and functional results
Both approaches can achieve effective cancer control in experienced hands, and the laboratory examines the removed prostate in the same way after either operation. For continence and erectile function, robotic surgery is often associated with good results, particularly when performed by an experienced surgeon using nerve-sparing techniques.
The evidence is worth understanding fairly. A randomised trial published in The Lancet in 2016 found similar urinary and sexual function at 12 weeks after robotic and open surgery, with less blood loss and a shorter hospital stay in the robotic group. This suggests that the skill of the surgeon matters at least as much as the method. Our article on why surgeon experience matters explores this further.
Which is used today
Robotic surgery is now the most common approach for radical prostatectomy at experienced UK centres, largely because of the faster recovery and the precision it offers. Open surgery remains a valid option in some situations, for example where robotic surgery is not available or where a surgeon has particular expertise in the open technique. What matters most is that the operation is carried out by an experienced surgeon working within a specialist team. Independent information is available from Cancer Research UK and the NHS.
Making the choice
The right approach depends on your diagnosis, general health and the expertise available. Previous abdominal surgery, a very large prostate or other medical conditions can all influence the recommendation. Questions worth asking include:
- Which approach do you recommend for me, and why?
- How many of these operations do you perform each year?
- What are your continence and erectile function results?
For many patients, robotic surgery offers a more comfortable recovery with equally effective cancer control. Our robotic prostatectomy page describes the operation Professor Dasgupta performs.
To discuss which approach would suit you, please contact the clinic to arrange a consultation.