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 via tiny incisions in the abdomen, without the need for a large incision. This gentle technique can significantly reduce 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 the 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 stress – with even greater freedom of movement and precision.
The removal of the prostate itself is performed under three-dimensional magnification, ensuring that the blood vessels and nerves crucial for continence and sexual function are preserved as much as possible. Unlike open surgery, laparoscopic Da Vinci surgery usually leads to a quicker recovery and a shorter stay in hospital.
Compared to conventional laparoscopic surgery, the Da Vinci method allows for even more precise control of the instruments and a clearer view of the tumor and surrounding tissue.
The procedure: How does a Da Vinci prostate removal operation work?
Robot-assisted radical prostatectomy (RARP) is a highly precise, minimally invasive procedure in which the prostate is completely removed.
The following procedure outlines how the operation is typically performed in a modern urology clinic:
1. Preparation and positioning
The patient is put under anesthesia and positioned in a special, slightly inclined position to ensure optimal access to the abdominal cavity.
The 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 the surrounding tissue to be spared with precision.
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.
Particular care is taken to preserve the structures vital for continence and potency.
4. Reconnection of the bladder and urethra
After the prostate has been removed, the surgeon precisely sutures the urethra and bladder together.
This suture is crucial for subsequent urinary continence. Thanks to the precision of the robotic-assisted system, the procedure can be performed with minimal damage to the surrounding tissue.
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 the operation. The catheter remains in place for just 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 operation, the prostate is completely removed and the connection between the urethra and the bladder is restored. The surgeon also checks that any 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 regarded as 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.
Advantages of the Da Vinci method
- Minimally invasive: only small skin incisions instead of a large abdominal incision
- Less pain and reduced blood loss after the procedure
- Better visibility: Thanks to three-dimensional magnification, the surgeon can identify nerves and blood vessels with precision
- Preservation of continence and potency: Gentle dissection protects the sphincter muscle and nerve pathways
- Faster recovery: Shorter hospital stay, usually just a few days
- Precision and safety: The Vinci system transmits the finest movements without tremor
Possible disadvantages and risks
- Higher costs than with conventional surgery
- Not every urology clinic has a robotic system
- As with any major operation, complications such as infections or post-operative bleeding may occur
- An experienced surgeon is crucial for an optimal outcome
The Da Vinci procedure is now regarded as the gold standard for robot-assisted surgery in urology. It is considered one of the safest and most precise surgical methods for treating prostate cancer worldwide.
Comparison: Open surgery vs. the Da Vinci method
| Feature | Open surgery | Da Vinci method (RARP) |
| Access route |
Large abdominal incision |
Several small skin incisions |
| Precision |
Limited by field of view |
High precision thanks to 3D optics |
| Blood loss |
Higher |
Significantly lower |
| Pain |
More severe |
Less pain |
| Hospital stay |
7–10 days |
3–5 days |
| Nerve preservation |
Limited |
Vessels and nerves spared |
| Continence/potency |
Later preservation |
Often rapid preservation of continence and potency |
| Long-term results |
Good |
Comparable or better |
Robot-assisted radical prostatectomy (RARP) offers significant advantages over open surgery in terms of precision, recovery and long-term results.
Nevertheless, the decision should be made on an individual basis in consultation with the urologist and the clinic, as the surgeon’s experience and technical equipment are crucial to the outcome.
As with any major operation, side effects may occur. Temporary urinary incontinence or erectile dysfunction are possible following prostate surgery.
However, thanks to robot-assisted surgery, continence and potency are usually better preserved than after open surgery. In rare cases, incontinence and impotence occur as permanent consequences, particularly if the tumor is very close to the nerve pathways.
Side effects: incontinence and erectile dysfunction
As with any major operation, side effects may also occur following radical prostatectomy using the Da Vinci system. Common temporary complaints include mild urinary incontinence, a burning sensation when urinating or a feeling of pressure in the lower abdomen. These symptoms arise 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 potency cannot always be avoided. During the robot-assisted surgery, the prostate is completely removed, and the nerves and blood vessels that are important for erectile function are located very close by.
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 physiotherapy and patience help to restore urinary continence and sexual function.
How long does recovery take after prostate surgery?
Following robot-assisted prostate surgery, the recovery process is usually faster than with open surgery. As the method is minimally invasive, only small skin incisions are required and there is less blood loss. The patient can often get out of bed the day after the operation and is discharged from hospital after a few days.
In the first few weeks following the procedure, a catheter may be required 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 of continence and sexual function.
Regular PSA checks during follow-up are important for the early detection of any possible recurrence of prostate cancer.
When is surgery advisable?
A radical prostatectomy is primarily recommended when a tumor is confined to the prostate and the patient is seeking curative, i.e. healing, treatment. Robotic-assisted surgery offers very good prospects of success, particularly in early-stage prostate cancer.
Surgery is advisable 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 where metastases are present, alternative treatments such as hormone therapy or radiotherapy are used.
Alternatives to radical treatment
Not every patient with prostate cancer requires immediate surgery.
In the case of slow-growing tumors, which are common in prostate cancer, so-called ‘active surveillance’ may be appropriate. This involves regular monitoring of the PSA level, with the urologist checking whether the tumor is progressing.
Alternatively, radiotherapy, hormone therapy or focal therapies may be considered for certain patients. These procedures are less invasive, but may offer lower chances of cure in the long term if the cancer becomes more aggressive.
If functional limitations such as urinary incontinence or erectile dysfunction occur after the operation, 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 Da Vinci surgery, a camera and instruments are inserted into the abdominal cavity via small laparoscopic incisions. The surgeon controls the robot from a console. During the operation, the prostate, along with the seminal vesicles and, if necessary, lymph nodes, is removed without unnecessarily damaging surrounding tissue.
What is the difference compared to 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 quicker recovery. Furthermore, the three-dimensional magnification allows for a more precise view of the surgical field.
How long do you stay in hospital after prostate surgery?
As a rule, the hospital stay following robot-assisted surgery is only around 3–5 days. The catheter is removed after a few days once the urine flow is stable. After around two weeks, many patients are physically fit again.
Can you become impotent or incontinent after the operation?
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.
How safe is the Da Vinci method in the long term?
Studies show that the Da Vinci method delivers excellent long-term results with a high cure rate and a low complication rate. It is regarded in modern urology as the standard for prostate surgery, particularly for locally confined prostate cancer.
