Robot-assisted radical prostatectomy (RARP)

Da Vinci surgery is a modern form of robot-assisted surgery that is used in urology, primarily for radical prostatectomy. It enables the surgeon to perform surgery with the finest precision using a highly accurate robotic system. The so-called Da Vinci system transmits every hand movement of the surgeon to the surgical instruments in real time and with high precision.

This method is classified as a minimally invasive surgical technique: Instead of a large abdominal incision, only a few small skin incisions are required, through which a camera and fine instruments are inserted. The system provides up to 10x magnification and a three-dimensional view of the surgical field. This allows the surgeon to optimally identify blood vessels and nerves surrounding the prostate and to work with precision while minimizing tissue damage.

During robot-assisted radical prostatectomy (RARP), the surgeon completely removes the prostate along with the seminal vesicles and—depending on the extent of the tumor—the lymph nodes as well. The Da Vinci robot is not an autonomous device, but rather a highly sophisticated tool that is manually controlled by the surgeon.
This combination of human experience and technical precision makes Da Vinci surgery one of the safest and least invasive methods of prostate surgery.

Thanks to the magnification and three-dimensional visualization of the surgical field, the surgeon can identify even the smallest structures—a decisive advantage over conventional retropubic surgery.

Da Vinci robot used for robot-assisted radical prostatectomy at a urology clinic—precise, minimally invasive prostate surgery.

Laparoscopic removal of the prostate—also known as minimally invasive prostate surgery—forms the basis for robot-assisted radical prostatectomy (RARP).
In this procedure, the prostate is removed through tiny incisions in the abdomen without the need for a large incision. This minimally invasive technique significantly reduces blood loss, pain, and recovery time.

While in traditional laparoscopy the instruments are guided directly by hand, in the Da Vinci method the robot takes over precise control. The surgeon sits at a console and operates the instruments, which are inserted through small incisions. This robot-assisted surgery combines the advantages of laparoscopy—namely, small skin incisions and minimal trauma—with even greater freedom of movement and precision.

The prostate removal itself is performed under three-dimensional magnification, which ensures that the blood vessels and nerves critical for continence and sexual function are preserved as much as possible. Unlike open surgery, laparoscopic Da Vinci surgery usually results in a faster recovery and a shorter hospital stay.

Compared to traditional laparoscopic surgery, the Da Vinci method allows for even more precise control of the instruments and a more stable view of the tumor and surrounding tissue.

Robot-assisted radical prostatectomy (RARP) is a highly precise, minimally invasive procedure in which the prostate is completely removed.
The following steps outline how the surgery is typically performed in a modern urology clinic:

1. Preparation and Positioning

The patient is placed under anesthesia and positioned at a slight angle to ensure optimal access to the abdominal cavity.
A camera and instruments are inserted through several small incisions in the skin—a large abdominal incision is not necessary.

2. Control via the robotic system

The surgeon controls the Da Vinci robot from a console.
The robotic system transmits the surgeon’s hand movements in real time to tiny instruments working inside the patient’s body.
Thanks to three-dimensional magnification, the surgeon sees the surgical field in the highest resolution—allowing nerves, blood vessels, and surrounding tissue to be carefully preserved.

3. Removal of the Prostate

First, the seminal vesicles and the prostate are separated from the surrounding tissue. The prostate is then removed along with the tumor tissue.
Special care is taken to preserve the structures critical for continence and sexual function.

4. Reconstruction of the connection between the bladder and the urethra

After the prostate is removed, the surgeon precisely sutures the urethra and bladder together.
This suture is crucial for future urinary continence. Thanks to the precision of the robotic-assisted system, the procedure can be performed with minimal tissue trauma.

5. Conclusion and Initial Recovery

At the end of the procedure, the surgeon checks the integrity of the suture and the patency of the urinary tract.
The patient is usually able to get out of bed the day after surgery. The catheter remains in place for only a few days until healing is complete.

Robot-assisted prostate surgery offers significant advantages over open surgery due to its precision, reduced blood loss, and faster recovery. During the surgery, the prostate is completely removed and the connection between the urethra and the bladder is restored. The surgeon also checks to ensure that residual urine can drain freely. In many cases, preserving the nerves helps maintain erectile function.

Robot-assisted surgery using the Da Vinci system is now considered a modern advancement of traditional open surgery for prostate cancer.
It combines the surgeon’s experience with the technical precision of a robotic system, thereby enabling a surgical technique that is particularly gentle on the tissue.

• Minimally invasive: Only small skin incisions instead of a large abdominal incision
• Less pain and less blood loss after the procedure
• Better visibility: Thanks to three-dimensional magnification, the surgeon can precisely identify nerves and blood vessels
• Preservation of continence and sexual function: Gentle dissection protects the sphincter muscle and nerve pathways
• Faster recovery: Shorter hospital stay, usually only a few days
• Precision and safety: The Vinci system transmits the finest movements without tremors

• Higher costs than with conventional surgery
• Not every urology clinic has a robotic system
• As with any major surgery, complications such as infections or postoperative bleeding may occur
• An experienced surgeon is crucial for an optimal outcome

The Vinci procedure is currently considered the gold standard for robot-assisted surgery in urology. It is regarded worldwide as one of the safest and most precise surgical methods for treating prostate cancer.

Robot-assisted radical prostatectomy (RARP) offers significant advantages over open surgery in terms of precision, recovery, and long-term outcomes.
Nevertheless, the decision should be made on an individual basis in consultation with the urologist and the clinic, as the surgeon’s experience and the technical equipment available are crucial to the outcome.

As with any major surgery, side effects may occur. Temporary urinary incontinence or erectile dysfunction are possible after prostate surgery.
However, thanks to robot-assisted surgery, continence and sexual function are usually better preserved than after open surgery. In rare cases, incontinence and impotence may occur as permanent consequences, especially if the tumor is located very close to the nerve pathways.

As with any major surgery, side effects may occur even after a radical prostatectomy performed using the da Vinci system. Common temporary symptoms include mild urinary incontinence, a burning sensation when urinating, or a feeling of pressure in the lower abdomen. These symptoms occur because the surgery affects the area around the urethra and the sphincter muscle.

Despite state-of-the-art surgical techniques, temporary impairment of continence and erectile function cannot always be avoided. During robot-assisted surgery, the prostate is completely removed, and the nerves and blood vessels essential for erectile function are located in close proximity.
However, thanks to the three-dimensional magnification and high precision of the Da Vinci method, these structures can usually be preserved.

Erectile function often recovers within a few months. In rare cases, long-term erectile dysfunction may occur. Pelvic floor exercises, targeted physical therapy, and patience support the restoration of urinary continence and sexual function.

After robot-assisted prostate surgery, the healing process is usually faster than with open surgery. Since the method is minimally invasive, it involves only small incisions and minimal blood loss. The patient can often get out of bed the day after surgery and is discharged from the hospital after a few days.

In the first few weeks after the procedure, a catheter may be necessary until the connection between the urethra and the bladder has fully healed. During this time, there may be temporary, slight urine leakage until the sphincter muscle stabilizes again.

Full recovery usually takes several weeks. The long-term results of Da Vinci surgery are very good: Many patients report a rapid return to continence and sexual function.
Regular PSA checks during follow-up care are important for the early detection of a possible recurrence of prostate cancer.

A radical prostatectomy is primarily recommended when a tumor is confined to the prostate and the patient is seeking curative treatment. Robotic-assisted surgery offers very good prospects for success, particularly in cases of early-stage prostate cancer.

Surgery is recommended if:

• the tumor is locally confined and operable,
• the patient is in good general health,
• life expectancy allows for a long-term cure,
• there are no contraindications for anesthesia.

In advanced stages or in cases of metastasis, other therapies such as hormone therapy or radiation therapy are used as alternatives.

Not every patient with prostate cancer requires immediate surgery.
For slow-growing tumors, which are common in prostate cancer, a strategy known as “active surveillance” may be appropriate. This involves regularly monitoring the PSA level, and the urologist checks to see if the tumor is progressing.

Alternatively, radiation therapy, hormone therapy, or focal therapies may be considered for certain patients. These procedures are less invasive but may offer lower long-term chances of cure if the cancer becomes more aggressive.

If functional limitations such as urinary incontinence or erectile dysfunction occur after surgery, reconstructive urology can help. Through targeted procedures or implants, continence can be restored and quality of life improved.

How is a radical prostatectomy performed using the Da Vinci system?

During a Da Vinci procedure, a camera and instruments are inserted into the abdominal cavity through small laparoscopic incisions. The surgeon controls the robot from a console. During the surgery, the prostate, along with the seminal vesicles and, if necessary, lymph nodes, is removed without unnecessarily damaging surrounding tissue.

What is the difference from open surgery?

Unlike traditional retropubic prostatectomy, the Da Vinci method is minimally invasive. It causes less pain, results in less blood loss, and usually leads to a faster recovery. In addition, the three-dimensional magnification provides a more precise view of the surgical field.

How long do you stay in the hospital after prostate surgery?

Typically, the hospital stay after robot-assisted surgery is only about 3–5 days. The catheter is removed after a few days once urine flow is stable. After about two weeks, many patients are physically active again.

In the short term, yes—due to the proximity of the nerves, incontinence or impotence may occur. In most cases, however, these symptoms are temporary. Robot-assisted surgery using the Da Vinci system preserves the nerves responsible for continence and erectile function.

Studies show that the Da Vinci method yields excellent long-term results with a high cure rate and a low complication rate. It is considered the standard of care in modern urology for prostate surgery, particularly for locally confined prostate cancer.