A Robotic Assisted Simple Prostatectomy (RASP) is a specialized surgical procedure used to treat severe symptoms of Benign Prostatic Hyperplasia (BPH), or an enlarged prostate. It is considered “simple” because it removes only the overgrown inner portion of the prostate gland, known as the adenoma, while preserving the outer capsule. RASP is a minimally invasive technique utilizing a robotic surgical system, which provides surgeons with enhanced vision and precision. This approach is an alternative to traditional open surgery for men whose enlarged prostates cause significant urinary issues.
Indications and Advantages of the Minimally Invasive Approach
The primary indication for RASP is a significantly enlarged prostate gland causing severe lower urinary tract symptoms, such as difficulty urinating or the inability to empty the bladder completely. This procedure is recommended for men with prostatic adenomas weighing 80 to 100 grams or more, especially when less invasive endoscopic treatments like Transurethral Resection of the Prostate (TURP) or Holmium Laser Enucleation of the Prostate (HoLEP) are impractical due to tissue size. Patients who have failed medical therapy or have concomitant issues like bladder stones may also be candidates.
The robotic, minimally invasive approach offers several advantages over traditional open simple prostatectomy. RASP requires only five to seven small “keyhole” incisions, each about a centimeter or less, rather than the single, large incision used in open surgery. This results in a lower perioperative morbidity profile. The enhanced visualization and precise instrument control provided by the robotic system allow for meticulous control of bleeding vessels, resulting in a lower chance of blood transfusion. Patients experience less post-operative pain and discomfort, contributing to a faster recovery and a shorter hospital stay, often resulting in discharge within one to three days.
The Mechanics of the Procedure
The RASP procedure is performed under general anesthesia. The surgeon begins by making several small abdominal incisions, or ports, through which a high-definition camera and robotic instruments are inserted. Carbon dioxide gas is used to inflate the abdominal cavity (insufflation), creating a working space and improving visualization.
The surgeon controls the robotic arms from a console located a short distance from the operating table, using hand and foot movements that the system translates into precise micro-movements of the instruments. This technology provides the surgeon with a magnified, three-dimensional view of the prostate, allowing for fine dissection and tissue handling.
The core action is the enucleation, or “shelling out,” of the obstructive adenoma. The surgeon accesses the prostate, often through a small incision in the back wall of the bladder, and carefully develops the plane between the enlarged inner tissue and the outer prostatic capsule. Using the robotic instruments, the surgeon separates and removes the obstructing prostatic lobes, comparable to removing the flesh of an orange while leaving the rind intact.
Once separated, the tissue is removed from the body, usually through morcellation (where the tissue is broken down and suctioned out) or by extraction through an enlarged port site. After removal, the incision in the bladder is meticulously closed with sutures. A flexible tube, known as a urinary catheter, is then inserted through the urethra into the bladder to ensure drainage and allow the surgical area to heal properly.
Post-Operative Care and Recovery Timeline
Immediately following the procedure, the patient is moved to a recovery area for monitoring and pain management. The hospital stay after RASP is short, usually lasting between one and three days. During this initial period, the urinary catheter remains in place, and continuous bladder irrigation may be used temporarily to flush out small blood clots.
The most significant aspect of recovery involves the indwelling urinary catheter, which allows the bladder and internal surgical site to heal completely. The catheter is commonly left in place for about 7 to 14 days. Before removal, a test, such as a cystogram, may be performed to confirm the bladder closure has healed and is watertight.
After catheter removal, patients often notice an immediate improvement in urinary flow. However, temporary side effects are common. Urinary frequency, urgency, and light blood in the urine can occur for several weeks as the bladder adjusts to the new channel. Some men may also experience temporary urinary leakage, or stress incontinence, which improves as the pelvic floor muscles regain strength.
Patients are advised to avoid strenuous activities, heavy lifting (over 10 pounds), and vigorous exercise for four to six weeks to prevent straining healing tissues. Most individuals can return to light, desk-based work and resume driving within one to two weeks. While initial recovery is quick, the full benefit of the surgery, including the resolution of irritative urinary symptoms, continues to improve for up to three to six months.