A robotic prostatectomy is a minimally invasive surgery that uses a computer-controlled robotic system to remove the entire prostate gland, typically as treatment for prostate cancer. The surgeon operates from a console a few feet from the patient, controlling robotic arms that hold a camera and surgical instruments inserted through several small incisions in the lower abdomen. It has become the most common approach to prostate removal in the United States, largely replacing traditional open surgery over the past two decades.
How the Surgery Works
The procedure is performed under general anesthesia. You’re positioned with your head tilted downward at roughly 30 to 45 degrees, a posture called the Trendelenburg position. This angle lets gravity pull the abdominal organs away from the pelvis, giving the surgeon a clearer view of the prostate. Your abdomen is then inflated with gas to create working space for the instruments.
The surgeon sits at a nearby console and looks through a viewer that provides a magnified, three-dimensional image of the surgical field. From there, they guide robotic arms that translate their hand movements into precise micro-movements inside your body. The robot doesn’t make decisions on its own. It’s entirely controlled by the surgeon, but it filters out hand tremors and allows a level of precision that’s difficult to achieve with human hands alone through small incisions.
During the operation, the surgeon separates the prostate from the bladder and urethra, carefully works around the nerves that control erections and bladder function, and removes the entire gland along with the seminal vesicles. Nearby lymph nodes may also be removed if there’s concern about cancer spread. The bladder is then reconnected to the urethra, and the prostate is extracted through one of the small incision sites.
Robotic vs. Open Surgery
The biggest practical differences between robotic and open prostatectomy show up in blood loss and recovery time. During open surgery, estimated blood loss typically ranges from 300 to 600 milliliters. With the robotic approach, that drops to roughly 50 to 200 milliliters. Transfusion rates reflect this gap: one study found 8% of robotic patients needed a blood transfusion compared to 21% of open surgery patients.
Recovery is meaningfully faster with the robotic approach. Most people return to normal activities within four to six weeks after robotic surgery, compared to about eight weeks after an open procedure. If your job is primarily desk work, you can often return in two to three weeks. More physical jobs typically require four to six weeks off.
What Recovery Looks Like
You’ll leave the hospital with a urinary catheter, which generally stays in place for 10 to 14 days after a radical prostatectomy. This is one of the less comfortable parts of recovery, but it’s necessary to let the connection between your bladder and urethra heal. You’ll need to avoid heavy lifting and strenuous exercise for several weeks while your incision sites close up.
The two side effects that matter most to patients are urinary leakage and changes in erectile function. Both are common in the short term, and both improve over time for most men.
Urinary Continence After Surgery
Regaining full bladder control is a gradual process. At three months after surgery, about 30% of men are fully continent (using zero pads). By six months, that number climbs to roughly 58%, and by 12 months, about 79% of men have regained continence. The range across studies is broad: 72% to 96% at the one-year mark, depending on the surgeon’s experience, the patient’s age, and how continence is defined. Younger, healthier men tend to recover faster. Pelvic floor exercises before and after surgery can speed the process.
Erectile Function and Nerve Sparing
The prostate sits next to bundles of nerves that control erections. Preserving these nerves during surgery is possible but depends on where the cancer is located and how aggressive it is. Surgeons use one of three approaches: bilateral nerve sparing (saving nerves on both sides), unilateral sparing (saving one side), or a semi-sparing technique that leaves a substantial portion of the nerve tissue intact even when the cancer sits close to it. During nerve-sparing procedures, surgeons use clips instead of heat-based tools near the nerve bundles, since thermal energy can cause damage even at a distance.
Among men who had normal erections before surgery, 87% of those who had bilateral nerve sparing reported erections sufficient for intercourse at 12 months. The rate was the same, 87%, for unilateral nerve sparing. For men who needed the more limited semi-sparing approach due to higher-risk disease, 53% recovered potency at 12 months. These numbers represent a best-case scenario from experienced surgical teams. Recovery of erections often takes many months and may involve medications or other aids during the interim period.
How Effectively It Removes Cancer
One key measure of surgical success is whether any cancer cells are found at the edge of the removed tissue, known as a positive surgical margin. For cancer confined to the prostate (stage pT2), positive margin rates in large studies range from about 8% to 13%. For more advanced cancer that has grown through the prostate wall (stage pT3), rates are higher, typically 29% to 34%. A positive margin doesn’t necessarily mean the cancer will return, but it does increase the likelihood that additional treatment like radiation may be recommended.
Positioning and Anesthesia Considerations
The steep head-down positioning required for the surgery puts extra pressure on the upper body for an extended period, usually two to four hours. This can cause facial swelling that resolves within a day or two. More rarely, the increased pressure affects the eyes. Serious vision complications are uncommon but represent one of the unique risks of the robotic approach compared to open surgery, where this positioning isn’t needed. Your anesthesia team monitors these effects throughout the procedure and adjusts the tilt when possible.
The Robotic Systems Used
The da Vinci surgical system, made by Intuitive Surgical, is by far the most widely used platform. Most hospitals performing robotic prostatectomies use either the da Vinci Xi or the newer da Vinci 5. The latest model introduced force feedback, meaning the surgeon can actually feel resistance when the instruments press against tissue. Previous models relied entirely on visual cues. The da Vinci 5 also offers improved imaging and a more ergonomic console. Surgeons experienced with earlier models report the transition requires minimal adjustment.
Who Is a Candidate
Robotic prostatectomy is primarily offered to men with localized prostate cancer, meaning the disease hasn’t spread beyond the prostate or has only minimally extended past it. The procedure is performed as a curative treatment, so it’s most appropriate when the goal is to eliminate the cancer entirely. Factors like prior abdominal surgeries, significant obesity, or certain cardiac and lung conditions can make the steep positioning and prolonged anesthesia riskier, and your surgical team will evaluate these on a case-by-case basis. Men with very large prostates or extensive prior pelvic surgery may also face a more technically challenging operation, though these aren’t absolute barriers with an experienced surgeon.