If you are preparing for robotic prostate surgery, it is natural to want to understand what happens during the procedure. Knowing the main steps can help you feel more informed about the operation and what to expect during your hospital stay. It can also make the treatment process feel less unfamiliar.
Robotic prostate surgery, also known as robot-assisted radical prostatectomy, involves removing the prostate gland and seminal vesicles through several small keyhole incisions. Depending on your cancer risk and treatment plan, your surgeon may also remove nearby lymph nodes during the same operation. The exact approach will be tailored to your individual circumstances.
Although robotic instruments are used, the operation is not performed by the robot itself. Your surgeon remains in full control throughout the procedure, operating the robotic arms from a specialised console. The system provides magnified vision and highly precise instrument movement, helping your surgeon perform each stage of the operation with accuracy.
Important Note: The Order of Surgical Steps Can Vary
The steps below describe a commonly used multi-port robotic prostatectomy pathway. Your surgeon may use a different route or alter the order depending on the robotic system, your anatomy, previous surgery, cancer location and whether a standard anterior, extraperitoneal or Retzius-sparing approach is planned.
Although the exact sequence can vary, the essential aims remain the same: remove the prostate and seminal vesicles, preserve appropriate surrounding structures, assess or remove lymph nodes when indicated, reconnect the bladder to the urethra and support safe recovery.
The Operation Starts With Careful Planning
The steps of robotic prostate surgery begin well before you enter the operating theatre. Your medical team reviews your MRI scan, biopsy results, PSA level, prostate size, cancer location, medical history, and any previous operations. This information helps build a clear picture of your individual situation.
Careful planning allows your surgeon to decide whether nerve-sparing is appropriate and whether lymph node removal may be needed. It also helps the anaesthetic team prepare for your procedure and recovery. These decisions are made before surgery to ensure the operation is planned as safely and effectively as possible.
Although the overall procedure follows the same principles, robotic prostate surgery is not identical for every patient. The surgical plan is tailored to your anatomy, cancer characteristics, and treatment goals. This personalised approach helps your team provide care that is appropriate for your specific needs.
The Main Stages of Robotic Prostate Surgery
| Stage | What Usually Happens | Why It Matters |
| Pre-operative planning | MRI, biopsy, PSA, health, medication and anaesthetic information are reviewed | Helps define the surgical plan and cancer assessment |
| Anaesthesia and positioning | General anaesthesia is given and you are placed in a controlled head-down position | Provides safe access to the pelvis |
| Port placement and docking | Keyhole ports are inserted, carbon dioxide creates working space and robotic instruments are connected | Allows the surgeon to operate within the pelvis |
| Access to the prostate | Tissue planes are opened according to the chosen surgical approach | Exposes the prostate and surrounding anatomy |
| Bladder-neck and posterior dissection | The bladder neck is divided, the seminal vesicles are mobilised and the back of the prostate is released | Separates the upper and posterior parts of the prostate |
| Side and nerve dissection | Blood vessels are controlled and the neurovascular bundles are preserved where oncologically appropriate | Balances cancer removal with functional preservation |
| Apical and urethral dissection | The prostate is separated from the sphincter area and the urethra is divided | Completes removal while aiming to preserve healthy urethral length |
| Lymph-node dissection when indicated | Pelvic lymphatic tissue is removed using a defined template | Provides additional pathological staging |
| Reconstruction | The bladder neck is sutured to the remaining urethra around the catheter | Reconnects the bladder to the urethra so the urinary tract can heal |
| Final checks and closure | The join is assessed, a drain may be placed, the specimen is retrieved and the wounds are closed | Completes the procedure and prepares you for recovery |
| Recovery and follow-up | Pain relief, mobilisation, catheter care, pathology review and PSA monitoring follow | Supports healing and monitors cancer outcomes |
Evidence Note: What Does Robotic Assistance Change?
Robotic assistance provides magnified vision and articulated instruments within the confined pelvic space, but it does not guarantee better cancer or functional outcomes. The surgeon’s technique, experience, patient selection and cancer characteristics remain important.
The 2026 EAU guideline summarises a randomised study of 326 patients in which robotic and open radical prostatectomy produced comparable urinary and sexual-function scores at longer follow-up. It also reports that some trials found less bleeding, shorter hospital stays and earlier continence recovery with robotic surgery.
A meta-analysis of five randomised trials involving 1,205 patients found no clear difference between robotic and conventional laparoscopic prostatectomy in twelve-month continence or oncological outcomes, although early continence and erectile recovery favoured robotic surgery in some groups.
For you, this means the robotic platform can help a trained surgeon carry out precise keyhole surgery, but the word “robotic” should not be interpreted as a guarantee of cancer clearance, urinary continence or erectile recovery.
You Meet the Surgical and Anaesthetic Team
On the day of surgery, your surgeon or another member of the surgical team will usually confirm your details, review the planned procedure, and check that the consent process has been completed. This is also an opportunity for you to ask any final questions before the operation begins. Clear communication at this stage helps ensure that everyone understands the treatment plan.
You will also meet the anaesthetist, who is responsible for your care during the operation and in the recovery area afterwards. They will discuss the anaesthetic, pain management, monitoring, and what you can expect immediately after surgery. This conversation allows you to raise any concerns and understand how your comfort and safety will be managed.
Before the procedure, your team may review your medications, allergies, fasting instructions, and any plans relating to blood-thinning medicines. They will also ask whether you have developed any new symptoms or health issues since your pre-operative assessment. It is important to let them know if anything has changed, even if it seems minor.
Final Safety Checks Are Completed
Before the operation begins, the theatre team carries out a series of important safety checks. These checks confirm your identity, the planned procedure, allergies, consent details, equipment requirements, and any special considerations. They are a routine part of preparing for surgery.
Some of the questions may seem repetitive, as different members of the team may ask for the same information. However, each check plays a role in reducing the risk of errors and helping ensure that your care is delivered safely. This process is used in operating theatres across the UK.
You will also have monitoring equipment attached before the anaesthetic is given. This may include heart tracing, blood pressure monitoring, and oxygen level monitoring. These systems allow the anaesthetic team to monitor your condition closely throughout the operation.
Anaesthesia Is Given
Robotic prostate surgery is usually performed under general anaesthesia, which means you will be asleep throughout the operation. Anaesthetic medicines are usually given through a vein, with additional medicines used as needed to keep you unconscious and pain-free throughout the procedure.
Once you are anaesthetised, the anaesthetic team continues to monitor you closely. They keep track of your breathing, circulation, temperature, fluid balance, and pain control throughout the operation. Their role is to maintain your safety and comfort from the beginning of the procedure until recovery.
After you are asleep, your anaesthetist will normally place a breathing tube into your windpipe to protect your airway and support your breathing during the operation. The exact airway technique will be chosen according to your health and anaesthetic assessment.
A Urinary Catheter Is Inserted
A urinary catheter is placed into the bladder during the operation. This soft tube allows urine to drain continuously while your body begins to heal after the prostate has been removed. Catheter insertion is a routine part of robotic prostate surgery.
The catheter plays an important role because the bladder needs to be reconnected to the urethra during the procedure. It helps protect this new connection and reduces strain on the area while healing takes place. This support is important during the early stages of recovery.
You will usually go home with the catheter still in place. It is often removed approximately seven to fourteen days after surgery, although the timing varies according to your surgeon’s protocol, the reconstruction and your recovery.
You Are Positioned Carefully
After anaesthesia has been given, you are positioned on the operating table to allow safe access to the pelvis. Robotic prostate surgery usually requires a head-down position, which helps move the bowel away from the area being operated on. This gives your surgeon more space to work during the procedure.
Before the operation begins, your arms, legs, pressure points, and nerves are carefully protected. The theatre team takes steps to reduce the risk of pressure-related injuries or nerve irritation during what can be a lengthy operation. Careful positioning is an important part of patient safety.
Although you will not be aware of this stage because you are asleep, it plays a key role in the procedure. Your theatre team spends time ensuring that you are positioned securely and comfortably before surgery starts. These preparations help support a safe operation and recovery.
The Skin Is Cleaned and Draped
Before the operation begins, the skin on your lower abdomen is cleaned with an antiseptic solution. This helps reduce the risk of infection and prepares the area for surgery. Sterile drapes are then placed around the operating site to create a clean surgical field.
Your surgeon carefully plans where the small keyhole incisions will be made. The exact position of these incisions may vary depending on your body shape, previous operations, and the robotic system being used. This planning helps ensure safe access to the prostate.
Although the incisions are small, robotic prostatectomy is still a major operation. Careful preparation is essential for maintaining a controlled and sterile environment throughout the procedure. These steps help support both safety and surgical precision.
Small Keyhole Incisions Are Made
Your surgeon makes several small incisions in your lower abdomen to begin the robotic procedure. These openings allow a camera and specialised robotic instruments to be inserted safely into your body. Each incision is carefully placed to provide access to the prostate while minimising disruption to surrounding tissues.
Through these small ports, your surgeon can operate deep within the pelvis using highly precise instruments. The camera provides a magnified view of the surgical area, allowing your surgeon to see important structures in great detail. This helps support accuracy throughout the operation.
Unlike traditional open surgery, you do not usually need one large abdominal incision with robotic prostatectomy. The use of small keyhole openings is one reason why you may experience smaller wounds and a different recovery process. However, it is still a major operation that requires careful planning and specialist surgical expertise.
The Abdomen Is Inflated With Gas
Carbon dioxide gas is used to gently inflate your abdomen during robotic prostate surgery. This creates space inside the body, allowing your surgeon to see the surgical area clearly and move the instruments safely. It is a standard part of keyhole surgical procedures.
The gas helps provide a clear view of the prostate, bladder, and surrounding structures throughout the operation. This additional space allows your surgeon to work with greater precision in a confined area of the pelvis. It is an important step in creating the conditions needed for robotic surgery.
Most of the gas is removed before the operation is completed. However, you may notice temporary bloating or shoulder-tip discomfort after surgery as the remaining gas is absorbed by the body. These symptoms are usually short-lived and improve as your recovery progresses.
The Robotic System Is Docked
Once the ports have been placed, the robotic arms are connected to the surgical instruments and camera. This stage is known as docking and prepares the robotic system for the operation. The process is carefully checked before the surgical procedure continues.
Your surgeon then moves to the robotic console and begins controlling the instruments. The robotic arms translate your surgeon’s hand movements into precise, scaled movements inside your body. This allows delicate surgical tasks to be performed with a high degree of accuracy.
While your surgeon operates from the console, the assistant surgeon and theatre team remain beside you at the operating table. Robotic prostate surgery is a team effort that relies on close communication and coordination throughout the procedure. Each member of the team plays an important role in supporting your care and safety.
The Surgeon Gains Access to the Prostate
Once the robotic system is ready, your surgeon carefully opens the tissue planes needed to reach the prostate. The following sections mainly describe a commonly used anterior transperitoneal approach. Retzius-sparing, extraperitoneal, single-port and other techniques may reach the prostate differently and alter the order of the surgical steps.
In a standard approach, your surgeon usually works through the space at the front of the bladder and prostate. Other techniques may use a different route to help preserve specific anatomical structures. Each approach is designed to provide safe access to the prostate while supporting the goals of the operation.
The aim at this stage is to expose the prostate clearly and safely. Your surgeon takes great care to protect nearby structures, including the bladder, bowel, ureters, blood vessels, nerves, and pelvic floor tissues. Preserving these structures where possible is an important part of achieving a successful outcome.
The Bladder and Prostate Are Identified
At this stage of the operation, your surgeon identifies the bladder, prostate, and the area where they join together. This junction is known as the bladder neck and serves as an important anatomical landmark during surgery. Careful identification of these structures helps guide the next steps of the procedure.
The bladder neck requires precise dissection because it will later be reconnected to the urethra after the prostate has been removed. Maintaining suitable healthy tissue in this area, where oncologically appropriate, can support a secure reconstruction. This stage is therefore an important part of the overall surgical plan.
The exact technique used may vary from one patient to another. Factors such as your prostate size, previous prostate procedures, cancer location, and individual anatomy can all influence how your surgeon approaches this part of the operation. Careful surgical judgement is essential throughout the process.
The Bladder Neck Is Opened
Your surgeon carefully separates the prostate from the bladder at the bladder neck. This allows the operation to progress towards the deeper structures located behind the prostate. The dissection must be performed with precision to maintain clear anatomical landmarks.
Opening the bladder neck is one of the technically important steps in robotic prostate surgery. It provides access to structures such as the seminal vesicles and helps prepare the area for reconstruction later in the operation. Careful technique at this stage can influence the next steps of the procedure.
Your surgeon aims to complete the planned prostate removal while preserving enough healthy bladder neck tissue for a secure reconstruction. Achieving this balance requires careful judgement and depends on your anatomy, cancer location, and overall surgical plan. Cancer control remains the priority throughout the operation.
The Seminal Vesicles Are Usually Removed
The seminal vesicles are small glands located behind the prostate that contribute fluid to semen. As part of a radical prostatectomy, your surgeon will usually remove both the prostate gland and the seminal vesicles. This is a standard step in the operation.
During this stage, your surgeon carefully identifies and separates the seminal vesicles from the surrounding tissues. The vas deferens, which are the tubes that carry sperm from the testicles, are also divided. These structures are removed as part of the specimen being taken out during surgery.
This part of the procedure requires careful dissection because several important structures lie nearby. Your surgeon works with a magnified view and precise instruments to remove the tissue safely while protecting surrounding anatomy. These steps help prepare the way for the remainder of the operation.
The Back of the Prostate Is Released
After the seminal vesicles have been identified and mobilised, your surgeon works behind the prostate to separate it from the tissue in front of the rectum. The seminal vesicles are normally removed with the prostate specimen.
This step requires particular attention because the rectum sits directly behind the prostate. Although rectal injury is uncommon, protecting the rectum is an important part of safe prostate cancer surgery. Your surgeon uses precise movements and careful technique to minimise risks.
Whenever possible, your surgeon follows natural tissue planes to separate the structures safely. The magnified view provided by the robotic system can be especially helpful during this stage. Good visibility and controlled instrument movement support accurate dissection around these delicate tissues.
Blood Vessels Around the Prostate Are Controlled
During robotic prostate surgery, the blood vessels surrounding the prostate are carefully sealed or divided as the gland is removed. Controlling these vessels helps minimise bleeding and gives your surgeon a clearer view of the surgical area throughout the procedure.
- Careful blood vessel control: The blood vessels around the prostate are sealed or divided in a controlled way to reduce bleeding.
- Precision with robotic instruments: Robotic technology allows your surgeon to perform delicate dissection and vessel sealing with a high level of accuracy.
- Enhanced surgical visibility: Less bleeding helps maintain a clearer view of the operating field, making it easier to work around important structures.
- Protection of surrounding tissues: Improved visibility and precise movements support the careful preservation of nearby nerves and other delicate anatomy where appropriate.
- Individual bleeding risk: The amount of bleeding can vary depending on factors such as your anatomy, prostate size, medications and the complexity of the surgery.
Robotic prostatectomy is often associated with less blood loss than open surgery, although bleeding risk varies between patients and procedures.
Nerve-Sparing Dissection May Be Performed
The neurovascular bundles lie along the sides of the prostate and contribute to erectile function. Your surgeon will usually have planned before the operation whether nerve-sparing may be appropriate on one side, both sides or neither side.
During the lateral dissection, your surgeon follows a tissue plane selected according to your MRI, biopsy findings, clinical stage and cancer location. The plan may be adjusted if the tissues appear different from what was expected or if cancer control requires wider removal.
Nerve-sparing may improve the potential for erectile recovery, but it cannot guarantee erections after surgery. Current EAU guidance recommends nerve-sparing when the risk of cancer extending beyond the prostate is acceptably low on the relevant side.
The Prostate Is Freed From the Pelvic Floor
The lower part of the prostate sits close to the urinary sphincter and pelvic floor muscles. These structures play an important role in urinary control after surgery and can affect how you recover afterwards. As a result, this stage of the operation requires particularly careful attention.
Your surgeon carefully separates the apex, or tip, of the prostate from the surrounding tissues. The goal is to complete the planned prostate removal while preserving as much healthy urethral and sphincter tissue as possible where this is oncologically appropriate. This approach is intended to support your recovery while maintaining effective cancer treatment.
This is one of the most delicate steps in robotic prostate surgery. A precise apical dissection can influence both cancer control and continence outcomes. For you, this means that careful surgical technique may play an important role in your urinary recovery after the operation.
The Urethra Is Divided
The urethra is the tube that carries urine from the bladder through the penis. Because it passes directly through the prostate, it must be divided as part of the prostate removal process. This is a necessary step in every radical prostatectomy.
Your surgeon carefully divides the urethra just beyond the prostate while aiming to preserve as much healthy length as possible. The urinary catheter helps identify the urethra and keeps the urinary system controlled during this stage of the operation. Careful technique is important to support reconstruction later in the procedure.
Once the urethra has been divided, the prostate is fully detached. It is placed into a specialised retrieval bag inside the abdomen. In many robotic procedures, the bag remains inside temporarily while the surgeon completes the planned lymph-node dissection, reconstruction and final checks.
The Specimen Is Retrieved Near the End of the Operation
The prostate and seminal vesicles are placed securely in a retrieval bag after they have been detached. The bag helps prevent direct contact between the specimen and the abdominal wounds.
In many multi-port operations, the specimen is removed after the bladder-to-urethra reconstruction and final surgical checks have been completed. One of the keyhole incisions may be enlarged slightly so that the bag can be taken out safely.
The specimen is then sent for permanent-section pathology. The pathologist assesses the cancer grade, pathological stage, surgical margins, seminal vesicles and any lymph nodes removed during the operation.
Pelvic Lymph Nodes May Be Removed
Some men have an extended pelvic lymph-node dissection during robotic prostatectomy. This is performed when the estimated risk of lymph-node involvement is high enough for the result to provide useful staging information.
Your surgeon considers factors such as PSA, biopsy Grade Group, clinical stage, MRI findings and validated risk calculations. The timing of the lymph-node dissection varies and may occur before or after parts of the prostate removal.
When performed, lymphatic tissue is removed from defined areas of the pelvis and sent for detailed pathological examination. Lymph-node removal can provide important staging information, but it may also introduce additional risks, including lymph-fluid collections known as lymphoceles. Not every patient requires this step. Your surgeon should explain before surgery whether lymph-node dissection is planned and why it is expected to be useful in your case.
The Bladder Is Reconnected to the Urethra
After the prostate has been removed, your surgeon needs to reconnect the bladder to the remaining urethra. This connection is known as the vesicourethral anastomosis and allows urine to pass normally once healing has taken place. It is one of the most important reconstructive steps of the operation.
Creating this join requires precise suturing deep within the pelvis. Your surgeon uses fine stitches to bring the bladder neck and urethra together carefully and securely. The robotic system can be particularly helpful at this stage because it allows highly controlled movements and accurate needle placement.
The quality of this reconstruction is important for healing after surgery. A secure connection supports healing of the bladder-to-urethra join and may reduce the risk of an early urine leak. Recovery of urinary continence also depends on several other factors, including the urinary sphincter, pelvic-floor function and individual healing.
The Join Is Checked
After the bladder and urethra have been reconnected, your surgeon may check the join to ensure it is watertight. This is often done by gently filling the bladder through the catheter and looking for any signs of leakage. The check helps confirm that the reconstruction is secure.
This check can identify a visible leak. If leakage is detected, your surgeon can place additional stitches to strengthen the join and support secure healing during the recovery period.
The urinary catheter remains in place after surgery to allow continuous drainage while the area heals. This helps protect the new connection and reduces strain on the tissues. For you, proper catheter care will be an important part of the early recovery process.
A Drain May Be Placed
In some cases, your surgeon may place a small drain near the area where the operation was performed. This tube allows fluid to drain from the pelvis during the early stages of recovery. The decision to use a drain depends on the details of your surgery and your surgeon’s preference.
The drain is usually temporary and is often removed within the first few days after the operation. Your medical team will monitor the amount and type of fluid being collected to help assess your recovery. Removal is typically straightforward and carried out on the ward.
Not every patient will require a drain after robotic prostate surgery. Practice can vary between surgeons and hospitals depending on their protocols and the circumstances of the procedure. Your team will explain what was done during your operation and what to expect afterwards.
The Robot Is Undocked and Incisions Are Closed
Once the main stages of the operation have been completed, the robotic instruments are removed and the robotic system is undocked. The carbon dioxide gas used during surgery is then released from your abdomen. This marks the end of the surgical part of the procedure.
Your surgeon closes the small incisions using stitches, clips, skin glue, or dressings, depending on the technique used at your hospital. One incision may be slightly larger than the others because it is used to remove the prostate specimen. The aim is to ensure the wounds heal safely and comfortably.
After surgery, your wounds will be checked regularly by the medical team. You should follow the advice you are given about wound care, dressings, and bathing. It is also important to watch for signs such as redness, swelling, discharge, or increasing pain and report any concerns promptly.
You Wake Up in Recovery
After the operation, you are moved to the recovery area while the anaesthetic gradually wears off. The recovery team monitors your breathing, blood pressure, oxygen levels, pain, nausea, urine output, and overall comfort. This close observation helps ensure that you are recovering safely after surgery.
When you wake up, you may feel drowsy, have a dry mouth, or notice some bloating and discomfort. These symptoms are common after general anaesthesia and keyhole surgery. Your medical team will provide medication and support to help you feel as comfortable as possible.
Your urinary catheter will already be in place when you wake up. You may also have a drip for fluids, wound dressings, compression stockings, and, in some cases, a drain. Your team will explain what each item is for and monitor your progress during the early recovery period.
Pain Control and Early Movement Begin
After robotic prostate surgery, pain is usually managed with regular pain relief. The type and amount of medication you receive will depend on your health, your recovery, and your medical team’s plan. If you are uncomfortable or your pain is not well controlled, you should let the staff know.
Early movement is encouraged because it can support your recovery and reduce the risk of problems such as blood clots, chest infections, stiffness, and delayed progress. Staying active as advised can help your body recover after the operation. Your team will guide you on when and how to start moving safely.
At first, you should only move as recommended by your nursing team. They will support you with simple steps such as sitting up, getting out of bed, standing, and walking. As you recover, your activity levels will gradually increase.
Blood-Clot Prevention Continues
Your medical team will assess your risk of developing a blood clot in the legs or lungs. Preventive measures may include compression stockings, intermittent leg-compression devices, early walking and anticoagulant injections.
Some patients are advised to continue blood-thinning injections after leaving hospital. The duration depends on your risk factors and local protocol, so follow the specific instructions provided by your surgical and anaesthetic teams.
Contact your medical team urgently if you develop new calf pain or swelling. Sudden chest pain, severe breathlessness, coughing up blood or collapse requires emergency medical assessment.
You Learn Catheter Care Before Going Home
Before you leave hospital, your nursing team will show you how to manage your catheter safely at home. This usually includes emptying the drainage bag, keeping the tubing secure, and understanding how to look after the catheter during your recovery. Learning these steps can help you feel more confident after discharge.
You should ask what to do if you notice any problems, such as the catheter not draining, urine leaking around the tube, fever, or heavy bleeding. These symptoms may need medical advice, so it is important that you know who to contact. Your healthcare team will provide guidance before you go home.
You will also be given information about when and where your catheter will be removed. The timing depends on your recovery and your surgeon’s plan. You should not try to remove or adjust the catheter yourself, as this could affect healing.
Recovery Continues at Home
Once you return home, your recovery continues gradually over the following weeks. You may feel tired, bloated, bruised, or less active than usual during the early stages. These changes are common after major surgery and usually improve as your body heals.
You should follow your own medical team’s advice about walking, lifting, driving, bathing, wound care, bowel habits, sexual activity, and returning to work. Your recovery timeline will depend on your general health, the details of your operation, and whether any complications occur. Everyone’s recovery journey is different.
You should seek urgent medical advice if you develop symptoms such as chest pain, shortness of breath, calf swelling, heavy bleeding, fever, severe abdominal pain, a blocked catheter, or a sudden worsening in your condition. If something does not feel right, contacting your healthcare team early is the safest approach.
Follow-Up and PSA Monitoring Complete the Process
Robotic prostate surgery does not finish when the operation is over. Your follow-up care is an important part of the treatment journey because your team needs to review your final pathology results, monitor your healing, and check your PSA levels after surgery. These appointments help assess your recovery and ongoing cancer control.
After radical prostatectomy, PSA is expected to become undetectable, although the result and timing should be interpreted using the laboratory assay and your clinical circumstances. The result must be interpreted alongside the final pathology report and the timing of the blood test.
NICE recommends that PSA should be checked no earlier than six weeks after radical treatment, at least every six months for the first two years and at least once a year after that. Your own schedule may be more frequent if the pathology or PSA result requires closer monitoring.
UK Guidance Note
The current BAUS robotic prostatectomy leaflet describes removal of the prostate and seminal vesicles, with lymph-node removal in selected cases. It states that the robotic instruments remain completely under the surgeon’s control, the operation commonly uses five or six keyhole incisions and the procedure usually takes approximately two to three hours. Most patients are discharged after one or two days, although individual recovery varies.
NICE recommends discussing the purpose and schedule of follow-up and explaining longer-term treatment effects. PSA should be measured no earlier than six weeks after radical treatment, at least every six months for the first two years and at least annually thereafter.
The precise catheter-removal date, hospital stay, blood-clot prevention plan and activity restrictions vary between hospitals. Your own surgeon’s and hospital’s instructions should therefore take priority over general timelines.
Myth vs Fact
| Myth | Fact |
| The robot performs the operation by itself. | Your surgeon controls every instrument movement from the console. |
| Every robotic prostatectomy follows exactly the same steps. | The route and order can vary according to the approach, anatomy and surgical plan. |
| The prostate is always removed from the abdomen immediately after it is detached. | In many procedures it is placed in a retrieval bag and removed near the end of the operation. |
| Every patient needs pelvic lymph nodes removed. | Lymph-node dissection is performed only when it is considered appropriate for staging and treatment planning. |
| Nerve-sparing guarantees normal erections. | It may improve the potential for recovery, but erections can still be affected. |
| Small incisions mean the procedure is minor surgery. | Radical prostatectomy remains a major pelvic operation with important risks and recovery needs. |
| The catheter can be removed whenever you feel ready. | It must remain until the bladder-to-urethra connection has had time to heal and should only be removed by the clinical team. |
| An undetectable first PSA means no further checks are needed. | Regular PSA monitoring remains necessary after surgery. |
| Robotic surgery always produces better long-term outcomes than open surgery. | It may offer perioperative advantages, but long-term outcomes also depend on cancer features and surgical expertise. |
Key Takeaways
- The robotic system assists your surgeon but does not perform the operation independently.
- The exact order of the surgical steps can vary depending on the approach, robotic system and your individual anatomy.
- The prostate and seminal vesicles are removed during radical prostatectomy.
- Pelvic lymph nodes may also be removed when the estimated risk of cancer spread makes this appropriate.
- Nerve-sparing may be performed on one side, both sides or neither side, depending on the location and extent of the cancer.
- The detached prostate is usually placed in a retrieval bag and may remain inside the abdomen until reconstruction and final checks are complete.
- The bladder is reconnected to the remaining urethra, and a catheter supports the new connection while it heals.
- Robotic prostatectomy remains major surgery despite the use of small keyhole incisions.
- Recovery may involve pain relief, early walking, catheter care, wound care and blood-clot prevention.
- Final pathology and regular PSA monitoring remain essential after surgery.
- Robotic surgery may offer some short-term recovery advantages, but it cannot guarantee cancer control, urinary continence or erectile-function recovery.
FAQs:
1. How long does robotic prostate surgery usually take?
Robotic prostatectomy usually takes approximately two to three hours, although it can take longer. Prostate size, previous surgery, the surgical approach, nerve-sparing, lymph-node removal and unexpected technical difficulty can all influence the duration.
2. Is robotic prostate surgery performed by a robot alone?
No. Your surgeon controls every movement of the robotic instruments from a specialised console. The robotic system provides magnified vision, tremor filtering and articulated instrument movement, but it does not make decisions or operate independently.
3. Will a catheter be needed after robotic prostate surgery?
Yes. A catheter allows urine to drain while the bladder-to-urethra connection heals. It commonly remains for approximately seven to fourteen days, although your surgeon may recommend a shorter or longer period depending on the operation and local protocol.
4. Are lymph nodes always removed during robotic prostate surgery?
No. Pelvic lymph-node dissection is based on the estimated risk of nodal involvement using PSA, biopsy Grade Group, clinical stage, imaging and validated risk assessment. When lymph-node dissection is performed, current EAU guidance recommends an extended dissection.
5. What is nerve-sparing during robotic prostate surgery?
Nerve-sparing involves choosing a dissection plane that aims to preserve one or both neurovascular bundles alongside the prostate. The plan is usually made before surgery and may be adjusted during the operation. It is only attempted when your surgeon considers it oncologically appropriate.
6. How soon can normal activities be resumed after surgery?
Recovery varies from person to person, but light walking is usually encouraged soon after surgery. More strenuous activities, heavy lifting, and exercise may need to be avoided for several weeks. Return to work depends on the type of job and individual recovery. Specific guidance should always come from the treating surgical team.
7. Is pain common after robotic prostate surgery?
Some discomfort is normal after robotic prostate surgery, but pain is usually managed with medication. You may experience soreness around the incision sites, abdominal bloating or mild pelvic discomfort. Pain levels vary depending on the individual and the complexity of the procedure. Any severe or worsening pain should be reported to the medical team.
8. When will the pathology results be available after surgery?
The timing varies between hospitals. Your pathology report is usually discussed after the laboratory has completed permanent-section examination and the findings have been reviewed by the clinical team or multidisciplinary team. Your hospital should tell you when and how the results will be provided.
9. When is PSA checked after robotic prostate surgery?
NICE recommends checking PSA no earlier than six weeks after radical treatment. It should then be checked at least every six months for the first two years and at least once a year thereafter, although your surgeon may recommend more frequent testing according to your pathology and PSA result.
10. What are the potential advantages of robotic prostate surgery?
Robotic prostatectomy uses keyhole incisions, magnified vision and articulated instruments. Compared with open surgery, some studies have reported less blood loss, shorter hospital stays and quicker early recovery. However, robotic surgery does not guarantee better long-term cancer control, urinary continence or erectile function, and outcomes depend heavily on patient selection and surgical expertise.
Final Thoughts: Understanding the Steps of Robotic Prostate Surgery
Robot-assisted radical prostatectomy involves several carefully coordinated stages, including pre-operative planning, general anaesthesia, positioning, keyhole access, prostate dissection, possible nerve-sparing or lymph-node removal, urinary reconstruction and postoperative recovery. The precise order is not identical for every patient. Your surgeon may use a standard anterior, extraperitoneal, Retzius-sparing or another approach according to your anatomy, previous surgery, cancer characteristics and functional priorities.
Robotic assistance provides magnified vision and precise instrument control, but it does not remove the risks associated with major prostate surgery or guarantee cancer, continence or erectile outcomes. Final pathology, catheter management and regular PSA monitoring remain essential parts of the treatment process.
If you are considering treatment at a specialist robotic prostate surgery clinic in London, a detailed consultation should explain how the operation will be adapted to your situation, which additional steps may be needed and what support will be available throughout recovery.
References:
- National Institute for Health and Care Excellence (NICE) (2019, last updated 2021; reviewed 2025) Prostate cancer: diagnosis and management. NICE guideline NG131. Available at: https://www.nice.org.uk/guidance/ng131
- National Institute for Health and Care Excellence (NICE) (2018, last updated 2019) Venous thromboembolism in over 16s: reducing the risk of hospital-acquired deep vein thrombosis or pulmonary embolism. NICE guideline NG89. Available at: https://www.nice.org.uk/guidance/ng89
- European Association of Urology (EAU) (2026) EAU guidelines on prostate cancer: treatment. Available at: https://uroweb.org/guidelines/prostate-cancer/chapter/treatment
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