The location of the incision depends on which type of prostate surgery you’re having. For the most common approach today, robotic-assisted surgery, five or six small incisions are made across the lower abdomen. For open surgery, a single vertical cut runs from the belly button down to the pubic bone. Some procedures for enlarged prostate require no external incision at all, with instruments passed through the urethra instead.
Robotic-Assisted Surgery Incisions
Robotic-assisted laparoscopic prostatectomy is now the most widely performed technique for prostate cancer removal. It uses a total of about six small incisions spread across the lower abdomen in a fan-shaped pattern. The first port is typically placed at the upper edge of the belly button and is roughly 12 millimeters wide. The remaining ports, used for the robotic instruments, are smaller. A camera and miniature surgical tools are threaded through these openings, and the surgeon controls the instruments from a console nearby.
Mayo Clinic describes the setup as one 1- to 2-inch cut plus five much smaller cuts in the lower belly. Once the prostate is removed, the specimen comes out through a slight extension of the belly button incision. The small port sites are then closed. Because the cuts are so small, scarring is minimal and most patients find the cosmetic result noticeably better than with open surgery.
Single-Port Robotic Surgery
A newer variation uses the da Vinci SP (Single Port) system, which consolidates the camera and three articulating instruments into a single 27-millimeter port. This means only one incision is needed. Depending on the surgical approach, that single cut is placed in one of three locations: a small midline incision (under 3 centimeters) just above the pubic bone, a similar cut near the belly button, or a crescent-shaped incision in the perineum (the area between the scrotum and the anus). Single-port surgery is still newer and not available at every center, but it represents a step toward even less visible scarring.
Open Retropubic Prostatectomy Incisions
In an open radical retropubic prostatectomy, the surgeon makes a single vertical incision running from the belly button down to the pubic bone. This cut is typically around 8 centimeters long, though it can be longer depending on the patient’s anatomy. The incision gives the surgeon a direct, full view of the prostate and the surrounding structures, including the lymph nodes and the bundles of nerves responsible for erections and bladder control.
Some surgeons use a modified horizontal incision along the bikini line (called a Pfannenstiel incision), which is the same type of cut used in cesarean sections. This variation produces a less noticeable scar, tends to cause less postoperative pain, and requires fewer pain medications during recovery. It’s less common than the vertical approach but worth asking about if cosmetic outcome matters to you.
Perineal Prostatectomy Incisions
A radical perineal prostatectomy takes a completely different path. Instead of going through the abdomen, the incision is made in the perineum, the small area of skin between the scrotum and the anus. The cut is typically 3 to 4 centimeters long. Because this incision is hidden between the legs, it leaves no visible scar on the abdomen at all.
The perineal approach is less commonly performed today, partly because it makes it harder to access and remove nearby lymph nodes during the same operation. However, it avoids cutting through abdominal muscles entirely, which can mean less pain and a somewhat faster physical recovery for some patients.
Transurethral Procedures: No External Incision
If you’re having surgery for an enlarged prostate (benign prostatic hyperplasia) rather than cancer, the procedure may not involve any skin incision. Transurethral resection of the prostate (TURP) and holmium laser enucleation (HoLEP) are both performed by threading a thin tube with a camera and surgical tools through the tip of the penis and into the urethra. The surgeon works entirely from the inside, trimming or removing excess prostate tissue that’s blocking urine flow. There are no cuts to the skin and no external scars.
What Recovery Looks Like by Approach
The size and location of your incision directly affect how you’ll feel afterward. Robotic and laparoscopic approaches consistently show less blood loss, faster return to normal activity, and better cosmetic results compared to open surgery. Most people who have robotic surgery can go home within one to two days and return to light activity within a couple of weeks. The small port-site scars fade significantly over time.
Open surgery, with its longer abdominal incision, generally involves a hospital stay of two to three days and a longer period before you can lift, drive, or exercise comfortably. The vertical midline scar is permanent but fades from red to a thin white line over several months. Perineal incisions heal well because the area stays protected, though sitting can be uncomfortable for the first week or two.
For transurethral procedures, recovery is the quickest. There’s no incision to heal externally, and most patients go home the same day or the next morning. Discomfort is mostly internal, with a temporary burning sensation during urination that resolves within a few days to a couple of weeks.
How Surgeons Choose the Approach
The type of incision you end up with isn’t purely a cosmetic decision. Your surgeon selects the approach based on whether the surgery is for cancer or an enlarged prostate, the size and location of the tumor, your body habitus, any previous abdominal surgeries, and what equipment and expertise are available at the hospital. Robotic surgery has become the default at most major medical centers for prostate cancer removal, but open surgery remains a fully effective option, particularly at institutions where robotic systems aren’t available or when the surgeon has extensive open experience. If you have a preference for a particular approach, raising it early in the conversation with your surgical team gives you the best chance of understanding your options.