If you have been advised to consider prostate cancer surgery, you may hear the terms “robotic prostate surgeon” and “open prostate surgeon”. These terms mainly describe the surgical technique your surgeon uses, rather than two completely different types of doctors, and your surgeon’s experience with the chosen approach can be important for you.
Both techniques can be used for radical prostatectomy, which removes your prostate and seminal vesicles, with pelvic lymph nodes sometimes removed when clinically appropriate. Robotic surgery is now widely used, but your surgeon remains in control throughout the operation, so the robot does not perform the surgery independently for you.
What Is a Robotic Prostate Surgeon?
A robotic prostate surgeon is a urological surgeon trained to perform prostate surgery using a robot-assisted surgical system. During a robotic radical prostatectomy, your surgeon sits at a console and controls specialised instruments inserted through several small abdominal incisions.
The system translates your surgeon’s hand movements into controlled movements of the surgical instruments and does not make decisions or operate independently. For you, this means the robot is a sophisticated surgical tool, while your surgeon’s experience, judgement and technical skill remain central to the procedure.
What Is an Open Prostate Surgeon?
An open prostate surgeon is a urologist trained to perform radical prostatectomy through a traditional surgical incision rather than robotic keyhole ports. In an open retropubic procedure, your surgeon usually reaches the prostate through an incision in your lower abdomen and removes the prostate and seminal vesicles using conventional surgical instruments.
Open radical prostatectomy has been used successfully for many years and remains an established treatment option. For you, the important factor is not simply whether your surgeon uses a robot, but their experience, technical skill and suitability of the recommended approach for your individual treatment.
Are Robotic and Open Surgeons Different Types of Doctor?
Robotic and open prostate surgeons are usually consultant urological surgeons with similar core training. Your surgeon may have experience with both techniques, while some surgeons develop greater expertise in robotic prostatectomy through specialist training, mentoring, simulation and extensive surgical practice.
The main difference is the technique and experience your surgeon has developed. If you are considering surgery, you can ask about your surgeon’s training, how often they perform the procedure and their experience with cases similar to yours, rather than choosing based only on whether they use robotic or open surgery.
Do Both Surgeons Perform the Same Operation?
Broadly, yes. Open and robot-assisted surgery are different approaches to radical prostatectomy, but the main oncological aim is the same: to remove the prostate and seminal vesicles. Pelvic lymph nodes may also be removed when clinically appropriate, and the bladder is then reconnected to the urethra.
The main difference is how your surgeon reaches and operates on these structures. Open surgery uses a larger incision, while robotic surgery uses several smaller keyhole incisions, but with either approach, the aim is effective cancer treatment while preserving urinary and sexual function where it is oncologically safe to do so.
How Does Robotic Prostate Surgery Work?
During robot-assisted radical prostatectomy, you are given a general anaesthetic before your surgeon makes several small incisions in your abdomen. A camera and specialised instruments are inserted through these openings, while your surgeon controls them from a console using a magnified three-dimensional view.
The system allows your surgeon to make precise movements within the pelvis during delicate parts of the operation. If you are considering robotic prostate surgery in London, you can ask about the technology being used, your surgeon’s experience and whether this approach is suitable for you.
How Does Open Prostate Surgery Work?
During an open radical prostatectomy, you are given a general anaesthetic before your surgeon makes a larger incision, usually in your lower abdomen, to reach the prostate. Your surgeon works directly through this opening using conventional surgical instruments to remove the prostate and reconstruct the urinary tract.
Unlike robotic surgery, open surgery gives your surgeon direct physical access to the tissues rather than using instruments controlled from a console. For you, the main priorities remain the same with either approach: removing the cancer effectively while protecting important nearby structures where it is safe to do so.
Robotic vs Open Radical Prostatectomy: Key Differences at a Glance
| Feature | Robot-assisted radical prostatectomy | Open radical prostatectomy |
| Surgical access | Several small abdominal incisions | Larger abdominal incision |
| Surgeon control | Instruments controlled by the surgeon from a console | Conventional instruments controlled directly by the surgeon |
| Surgical view | Magnified three-dimensional camera view | Direct operative view |
| Blood loss | Generally lower on average | Generally higher on average |
| Blood transfusion | Generally less likely | Generally more likely |
| Hospital stay | Often shorter | May be longer |
| Cancer-control aim | Removal of the prostate containing the cancer | Removal of the prostate containing the cancer |
| Continence and erectile outcomes | Influenced by patient, cancer and surgical factors | Influenced by patient, cancer and surgical factors |
| Surgeon experience | Important | Important |
How Does the Surgeon’s View Differ?
One major feature of robotic prostate surgery is the view available to the surgeon. Robotic systems provide a magnified, three-dimensional view that can help your surgeon see small structures around the prostate during delicate parts of the operation.
During open surgery, your surgeon views the anatomy directly through the incision and uses conventional instruments. Although robotic technology can provide enhanced visualisation, your surgeon’s experience, judgement and familiarity with the chosen technique remain important alongside the surgical approach itself.
Does Robotic Surgery Give the Surgeon Greater Precision?
Robotic systems provide your surgeon with highly manoeuvrable instruments and a magnified view, which can be useful when operating within the confined space of your pelvis. These technical features may help your surgeon make controlled movements during delicate parts of prostate surgery.
However, robotic surgery does not automatically mean greater precision or better results for you. Your surgeon’s experience, understanding of your anatomy, the location of your cancer and their ability to adapt during the operation all remain important factors in achieving a good outcome.
What Are the Differences in Blood Loss and Hospital Recovery?
Robotic radical prostatectomy is generally associated with less blood loss and a lower chance of needing a blood transfusion than open surgery. You may also have a shorter hospital stay with the minimally invasive approach, with smaller incisions potentially making your early recovery more comfortable.
However, a shorter hospital stay does not automatically mean better long-term results for you. Your overall health, the complexity of your surgery, your surgeon’s experience and any complications can all influence how quickly you recover and your longer-term urinary and sexual function.
Research Insight
Comparative evidence suggests that some of the clearest advantages of robot-assisted radical prostatectomy relate to peri-operative recovery. A randomised study reported similar urinary and sexual functional outcomes between robotic and open surgery at 24 months. A 2023 systematic review of prospective studies found lower blood loss, fewer transfusions and shorter hospital stays with robot-assisted surgery; it also reported better postoperative erectile-function recovery, while urinary continence recovery did not differ significantly.
However, differences in surgeon experience, patient selection, outcome definitions, cancer risk and follow-up mean that these findings should not be interpreted as a guarantee of better individual outcomes.
Is Cancer Control Better With a Robotic Surgeon?
The main goal of radical prostatectomy is to treat your prostate cancer effectively. Current evidence does not establish a simple, universal oncological advantage for one surgical approach. Some observational studies have reported differences in longer-term cancer outcomes, including the 12-year LAPPRO follow-up published in 2025, but these findings do not by themselves prove that the robotic approach causes better survival because the treatment groups were not randomised.
Your cancer stage and location, surgical planning, individual anatomy and your surgeon’s experience with the chosen approach can all influence your outcome alongside the type of surgery performed. Your pathology results and follow-up PSA tests will also help your specialist assess your cancer control and decide whether you need further treatment or monitoring.
What About Urinary Continence After Surgery?
Urinary leakage is a common concern after radical prostatectomy, and you may experience some temporary incontinence after your catheter is removed. Your recovery can vary depending on factors such as your age, urinary function before surgery, anatomy and pelvic-floor function.
Research comparing robotic and open surgery has produced mixed results, with some studies suggesting an advantage for robotic surgery while others find no clear long-term difference. When you discuss outcomes with your surgeon, ask how they define continence so you can understand exactly what their reported results mean for you.
What About Erectile Function?
Erectile dysfunction can occur after radical prostatectomy, whether you have robotic or open surgery. Your chances of recovering erections depend on factors such as your age, erectile function before treatment, general health and whether the nerves responsible for erections can safely be preserved.
Nerve-sparing is not suitable for every patient because your surgeon must prioritise cancer control when the tumour is close to these nerves. Some studies suggest better erectile recovery with robotic surgery, but the evidence is not consistent, so you should ask your surgeon about their nerve-sparing approach and outcomes.
Why Does the Surgeon’s Experience Matter So Much?
Your surgeon’s experience is an important consideration in radical prostatectomy, whichever surgical approach is used. Research has found associations between surgical volume and outcomes such as blood loss, operative time and surgical margins, although procedure volume alone does not determine surgical quality. You still rely on your surgeon’s judgement, technical skill and ability to adapt the procedure to your individual anatomy and cancer characteristics.
- Surgical experience: A surgeon who regularly performs radical prostatectomy may be more familiar with managing the technically demanding stages of the operation.
- Cancer removal: Your surgeon must carefully remove the prostate while aiming to achieve effective cancer control and protect nearby structures where appropriate.
- Functional outcomes: Your surgeon’s technique can influence factors such as urinary continence and the possibility of preserving the nerves involved in erectile function.
- Managing individual circumstances: An experienced surgeon can adapt the surgical plan according to your anatomy, tumour characteristics and any unexpected findings during the operation.
When choosing your surgeon, you can ask how frequently they perform radical prostatectomy and about their experience with patients whose circumstances are similar to yours. Understanding their approach to cancer control, continence, nerve-sparing and complications can help you make a more informed decision about your treatment.
Does Every Prostate Surgeon Perform Robotic Surgery?
No, not every urological surgeon performs robotic prostate surgery. If you are considering a robotic procedure, your surgeon needs specific training, access to the appropriate equipment and regular experience using the robotic system, while some urologists may focus on other areas of prostate care.
NICE guidance states that commissioners of urology services should consider providing robotic surgery for localised prostate cancer. This is a service-level recommendation and does not mean that robot-assisted surgery is automatically the right option for you; your cancer characteristics, overall health, preferences and other suitable treatments should all be considered.
UK Guidance Note
NICE recommends that robotic systems used for the surgical treatment of localised prostate cancer should be based in centres expected to perform at least 150 robot-assisted laparoscopic radical prostatectomies per year, specifically to ensure that the systems are cost-effective.
This is a service-level recommendation about where robotic systems should be based; it is not a minimum annual case number for an individual surgeon and does not guarantee a better individual outcome. Your treatment choice should still take account of your cancer characteristics, overall health, preferences and the potential benefits and risks of each appropriate option.
When Might Open Surgery Still Be Considered?
Open prostatectomy remains an established way of performing radical prostatectomy, even though robotic surgery is now widely used. Your surgeon may discuss an open approach because of their experience, available facilities or particular clinical circumstances, and a robotic procedure may occasionally need to be converted to open surgery if this is considered safer.
The choice should be based on what is most appropriate for you rather than assuming newer technology is always better. If open surgery is recommended, you can ask why it suits your situation and whether robotic surgery is available, while you can also ask what specific benefits a robotic approach may offer you.
How Should You Choose Between a Robotic and Open Prostate Surgeon?
Choosing your prostate surgeon involves more than comparing robotic and open surgery. You should first understand why radical prostatectomy is being recommended for you, what alternatives are available and how much experience your surgeon has with the proposed technique. You can also ask about their outcomes for cancer control, complications, urinary continence and erectile function.
It is worth discussing what your surgeon expects in your particular case, including whether nerve-sparing or lymph-node removal may be appropriate for you. You can also ask about catheter use, PSA follow-up and support with pelvic-floor rehabilitation or erectile-function recovery. If your surgeon discusses their results, it may help to ask how outcomes such as continence and erectile-function recovery are defined and over what period they are measured, as definitions can vary between surgeons and studies. This can give you a clearer understanding of what their reported outcomes may mean for you.
Myth vs Fact
| Myth | Fact |
| The robot performs prostate surgery by itself. | The robotic system does not operate independently. Your surgeon controls the camera and surgical instruments throughout the procedure. |
| A robotic surgeon is a completely different type of doctor. | Robotic and open prostate surgeons are generally urological surgeons. A robotic surgeon has additional training and experience in using a robot-assisted surgical system. |
| Robotic surgery always provides better cancer control. | Evidence does not show that robotic surgery universally provides superior cancer control. Cancer characteristics, surgical technique and surgeon experience are also important. |
| Robotic surgery guarantees continenceand erectile-function recovery. | Neither surgical approach can guarantee these outcomes. Recovery is influenced by factors including age, function before surgery, anatomy, nerve preservation and individual surgical circumstances. |
| Open prostate surgery is outdated. | Open radical prostatectomy remains an established surgical technique, although robot-assisted surgery is now widely used. The most appropriate approach depends on your individual circumstances and the expertise available. |
Key Takeaways
- A robotic prostate surgeon and an open prostate surgeon are both usually urological surgeons.
- The main difference is the surgical technique and the surgeon’s specific training and experience.
- Robotic technology can assist with visualisation and instrument movement, but the surgeon remains in control throughout.
- Your surgeon’s experience, your cancer characteristics, your general health and the suitability of the chosen approach all matter; the technology alone does not determine your outcome.
Frequently Asked Questions
1. Is robotic prostate surgery better than open surgery?
Robotic surgery can offer advantages such as smaller incisions, less blood loss and a shorter hospital stay, but it is not automatically better for every patient. Your cancer characteristics and your surgeon’s experience with the chosen technique are important when deciding which approach is suitable for you.
2. Is a robotic prostate surgeon a different type of doctor?
No. A robotic prostate surgeon is usually a urological surgeon who has received additional training and experience in using a robotic surgical system for prostate procedures. Some surgeons may also have experience performing open radical prostatectomy.
3. Does robotic surgery remove the prostate in the same way as open surgery?
The fundamental aim is the same. During radical prostatectomy, your surgeon removes the prostate and seminal vesicles, with pelvic lymph nodes also removed when clinically appropriate, but the surgeon reaches the prostate through smaller robotic ports rather than a larger open incision.
4. Does robotic prostate surgery cause less blood loss?
Generally, robotic radical prostatectomy is associated with less blood loss and a lower likelihood of needing a blood transfusion than open surgery. Your individual blood loss will depend on factors such as the complexity of your operation and your surgeon’s experience.
5. Does robotic surgery provide better cancer control?
There is no simple evidence that robotic surgery universally provides better cancer control than open surgery. Your cancer stage, tumour location, surgical technique and your surgeon’s ability to remove the cancer safely are important factors in your outcome.
6. Which approach has a better chance of preserving continence?
Both robotic and open radical prostatectomy can result in good urinary continence, although temporary leakage is common during recovery. Studies comparing the two approaches have produced mixed results, so you should ask your surgeon about their own continence outcomes and how they define successful continence.
7. Is erectile function better after robotic prostate surgery?
Some studies suggest that erectile recovery may be better following robotic surgery, but the evidence is not consistent. Your age, erections before surgery, general health and whether the cancer allows your surgeon to preserve the erectile nerves are particularly important.
8. Does the surgeon’s experience matter more than the surgical robot?
The technology is important, but your surgeon’s skill, experience and judgement remain central to your operation. You can ask how frequently your surgeon performs radical prostatectomy and what their outcomes are for complications, continence, erectile function and cancer control.
9. Can open prostate surgery still be used today?
Yes. Open radical prostatectomy remains an established surgical approach, although robotic surgery is now widely used. Your surgeon may recommend open surgery depending on their expertise, available facilities and your individual clinical circumstances.
10. How should you choose between a robotic and open prostate surgeon?
You should consider your surgeon’s experience, expected cancer outcomes, complication rates and experience with cases similar to yours rather than choosing solely based on the technology used. Asking about nerve-sparing, lymph-node removal, recovery, continence, erectile function and follow-up can help you make a more informed decision.
Final Thoughts: Choosing the Right Prostate Surgery Approach
Robotic and open prostate surgery can both be used to treat prostate cancer, but the best approach for you depends on your individual cancer characteristics, overall health and your surgeon’s experience. Robotic surgery may offer benefits such as smaller incisions, less blood loss and a shorter hospital stay, while your surgeon’s skill and judgement remain central to achieving a good outcome.
If you’re considering robotic prostate surgery in London and would like to talk through what the different approaches could mean for you, our team would be happy to discuss your options and arrange a consultation if that feels right for you.
References:
- National Institute for Health and Care Excellence (2019) Prostate cancer: diagnosis and management. NICE guideline NG131. Last reviewed 13 August 2025. Available at: https://www.nice.org.uk/guidance/ng131
- British Association of Urological Surgeons (2024) Robotic-assisted laparoscopic (keyhole) radical prostatectomy. Leaflet No. O24/103. Available at: https://www.baus.org.uk/patients/information_leaflets/180/roboticassisted_radical_prostatectomy_rarp
- British Association of Urological Surgeons (2024) Radical retropubic prostatectomy. Leaflet No. O24/106. Available at: https://www.baus.org.uk/patients/information_leaflets/109/radical_retropubic_prostatectomy
- Royal College of Surgeons of England (2025) Robotic-assisted surgery: A pathway to the future. Available at: https://www.rcseng.ac.uk/standards-and-research/standards-and-guidance/good-practice-guides/robotic-assisted-surgery/
- Coughlin, G.D. et al. (2018) ‘Robot-assisted laparoscopic prostatectomy versus open radical retropubic prostatectomy: 24-month outcomes from a randomised controlled study’, The Lancet Oncology, 19(8), pp. 1051–1060. Available at: https://pubmed.ncbi.nlm.nih.gov/30017351/
- Wang, J. et al. (2023) ‘Robot-assisted versus open radical prostatectomy: a systematic review and meta-analysis of prospective studies’, Journal of Robotic Surgery, 17(6), pp. 2617–2631. Available at: https://pubmed.ncbi.nlm.nih.gov/37721644/
- Lantz, A. et al. (2025) ‘Robotic versus open radical prostatectomy, differences in prostate cancer-specific survival—12 years of follow-up in the LAParoscopic Prostatectomy Robot Open Trial’, European Urology Oncology, 8(6), pp. 1524–1532. Available at: https://pubmed.ncbi.nlm.nih.gov/40413128/
- Godtman, R.A. et al. (2021) ‘Association of surgeon and hospital volume with short-term outcomes after robot-assisted radical prostatectomy: Nationwide, population-based study’, PLOS ONE, 16(6), e0253081. Available at: https://pmc.ncbi.nlm.nih.gov/articles/PMC8211177/