Robotic Prostatectomy –The Smart Technique

Robotic Prostatectomy –The Smart Technique

This type of Prostatectomy is a robotic-assisted Laparoscopic Radical Prostatectomy, where the laparoscopic robotic arms are controlled by a surgeon. The robot gives the surgeon much more dexterity than conventional laparoscopy while offering advantages over open prostatectomy: much smaller incisions, less pain, less bleeding, less risk of infection, faster healing time, and shorter hospital stay. While the cost of robotic prostate surgery is high, costs are declining rapidly.

What is Robotic Prostatectomy?

Thanks to breakthroughs in surgical technology, surgeons now widely offer a robotic assisted and minimally invasive option for prostatectomy - the Robotic Prostatectomy.

This procedure has the potential for significantly less pain, a shorter hospital stay, and faster return to normal daily activities. Overall, Robotic Prostatectomy does have the potential for better clinical outcomes. In addition, choosing to uses the robotic assisted approach further minimizes the physical and emotional impact of surgery on patients.

Why choose the Robotic Prostatectomy approach?

By dramatically enhancing dexterity, precision, control and visualization, the Robotics System overcomes the limitations of traditional laparoscopic technology. Helping surgeons to perform complex surgery in a manner never before experienced. The Robotc System extends the surgeon’s capabilities to provide these significant benefits:

  • Enhanced 3D view of the operating area
  • Improved dexterity
  • Greater surgical precision
  • Improved access
  • Increased range of motion
  • Reproducibility

By enhancing surgical capabilities, this approach offers a number of potential benefits, including:

  • Less pain following the operation
  • Less risk of infection
  • Less anesthesia
  • Less blood loss
  • Shorter hospital stay
  • Faster and more complete recovery
  • Quicker return to normal daily activities

It is important to know that ROBOTIC PROSTATECTOMY surgery does not place a robot at the controls; your surgeon is controlling every aspect of the surgery with the assistance of the robotics platform.



The SMART Surgery Technique takes less than 2 hours. The patient is positioned appropriately in the operating theater and the surgery is performed when the patient is placed under general anesthesia. The robotic system translates the surgeon’s hand movements outside the body into surgical movements inside the abdomen. This Technique for performing a ROBOTICALLY ASSISTED PROSTATECTOMY consists of 8 stages:

  • Stage1: Dropping the bladder
  • Stage 2: Bladder neck transection
  • Stage 3: Posterior bladder neck transected
  • Stage 4: Seminal vesicle (SV) dissection
  • Stage 5: Posterior dissection/nerve spar sparing/ EPF incision
  • Stage 6: DVC/Apical dissection
  • Stage 7: Bladder neck reconstruction
  • Stage 8: Urethrovesical anastomosis

The Benefits of Robotic Prostatectomy

This is the latest in minimally invasive surgery, offering the most recent advances in robotics and computer technology for a patient with prostate cancer.

This system allows our surgeons to be even more precise with ridding cancer from the prostate. Even difficult operations become routine with the Robotic System:

  • Manual Movements Translated Into Robotic Movements

With the use of the Robotic system, even through the small one-centimeter keyhole incisions, our surgeons are able to make incredible surgical maneuvers that would be impossible to make otherwise.

  • Controlled Incisions

Traditional open surgery involves large traumatic incisions to the patient and requires a longer healing time with the possibility of infection at the surgical site and considerable scarring.

Surgery Outcomes

With this operating system, patient recovery is so fast that many return to work in two to three weeks after this state of the art surgery.

Patients are pleasantly surprised to feel little if any sensitivity at the incisions sites and barely notice the scar tissue.

The system completely removes any cancer cells that are at the surrounding edge of the prostate. The elimination of any malignant cells at the surgical margins is critical to patient recovery.

Patients report a return of their sexual drive and their ability to attain an erection during sexual intercourse after prostate surgery. Also, they are glad to regain control of their bladder and report no problems with urination.


Removing the prostate gland, or part of it, during surgery can cause impotence and urinary incontinence. The ability to have an erection sometimes returns or at least improves over time. So does the ability to control urine leakage.

Destroying the prostate gland with radiation may cause impotence and incontinence, but not as much as surgery can. But radiation sometimes causes diarrhea and bowel problems.

Hormone therapy can cause loss of sex drive and erections, risk of weak bones (osteoporosis), hot flushes, and weight gain.



Before traveling to Cyprus, as part of your surgery preparation you will complete a detailed specific questionnaire, which will allow our doctors to determine your eligibility for your chosen procedure.

Ten days prior to your arrival in Cyprus, you will receive all the necessary pre operative instructions, to prepare yourself both physically and mentally for your chosen procedure.

Before your departure your records will be reviewed thoroughly by our surgeon. This includes X-rays and a complete medical and surgical history as well as your specific issues. In addition, you may be asked to consult with a physical therapist to discuss recovery, hip rehabilitation and important precautions you must take postoperatively. The physical therapist may even give you exercises you can begin prior to your surgery in order to aid with recovery.

After traveling to Cyprus, a new set of tests and X-rays (or other imaging) will be taken as well as an in person physical examination. The surgeon and anesthetist will also go through you medical and surgical issues with you. During this visit, your surgeon will discuss your surgical procedure and answer any questions.

Getting your house ready before your surgery

It is also important to get your house ready for after you come home from the hospital. At first it will be harder for you to move around, so arrange your furniture and household items ahead of time to make it easier for you during your rehabilitation.

  • Remove all your throw rugs or anything on the floor that may cause you to trip.
  • Move phone and electrical cords close to the walls.
  • Move necessary personal items you need to reach to shelves and tables that are above your waist level.

Preparation for the hospital

Here are a few things to keep in mind as you pack and prepare for the hospital and recuperation:

Getting dressed in the morning helps you feel better, so be sure to bring some comfortable clothing to the hospital:

  • Loose shorts or pants
  • Loose tops or T-shirts
  • Underwear and socks
  • Short robe or pajamas
  • Toiletries

Day before surgery

You may need to do a bowel prep to clean the stool out of your colon. Your doctor or nurse will give you more instructions based on the type of prep. You should not eat or drink anything after midnight the evening before your surgery.

Morning of surgery

Bring all your medicines in their original containers with you to the hospital. You will meet with the anesthesiologist. This doctor will talk to you about general anesthesia. This is a controlled sleep while the surgery is being done so you will not feel any pain or remember the surgery. You will have an IV or intravenous line put in to give you fluid and medicine during your surgery. When it is time for you to go to surgery, your family will be asked to wait in the waiting area. Your doctor will talk to your family there after your surgery is done.



When you wake up after your surgery, you will be in the recovery room. You will stay there until you are awake and your pain is under control. Most patients return to their room after a few hours.

You will receive oxygen through a thin tube called a nasal cannula that rests below your nose. A nurse will be monitoring your body temperature, pulse, blood pressure, and oxygen levels.

You will have an analgesia pump device to deliver pain medication into your IV or epidural space (in your spine). You will also have compression boots on your lower legs to help your circulation. They will be taken off when you are able to walk. You will also have 1 or 2 drains in your lower abdomen to drain extra liquid from the area. Most of the time, the drains are removed after a few days. If you will go home with a drain, your nurse will show you how to care for it.

Hospital discharge and home instructions

Your diet is slowly increased from ice chips to liquids to solid foods as your intestines start functioning.

Before leaving the hospital, our surgeon and staff will help you adjust to recovery in every way possible. You will receive specific instructions and precautions from your surgeon and nursing staff and they will show you safe techniques of simple activities like getting in and out of bed, bathing, going to the bathroom, managing steps at home and getting in and out of a car.

You will be able to leave the hospital when you are:

  • Able to eat a regular diet and drink fluids
  • Passing gas or you have had a bowel movement
  • Passing urine
  • Not having a fever or other signs of infection
  • Walk for short distances
  • Most people are able to go home on the day of their surgery.

The hospital stay after prostatectomy varies largely depending on the approach and ranges from 1 to 4 days, allowing for complete recovery.



Strenuous activity, constipation, and sexual activity should be avoided for about 6 weeks. Symptoms such as frequent urination will continue for a while because of irritation and inflammation caused by the treatment, but they should ease during the first 6 weeks.

These guidelines give you an overview of what you may expect as part of your care after you leave the hospital. Be sure to follow your doctor’s discharge instructions if they are different from what is listed here.

Your Activity                                                                                                                                                                   It is fairly common to feel weak and tired immediately after discharge from the hospital. The body needs time to recover from the stress of surgery.

  • Walking is permitted and encouraged beginning the same day of surgery. At home, start short, daily walks and gradually increase the distance you walk.
  • Going up and down stairs is permitted. Initially, have someone assist you.
  • You may lift light objects (less than 10lbs.) after your discharge. This may be increased gradually after 2 weeks. If lifting an object causes discomfort, you should discontinue the activity. This restriction helps prevent hernias at the sites of your incisions.
  • Showers are permitted 2 days after surgery. Wash over your incisions gently with soap and water. Be careful to rinse well. Pat the incisions dry.
  • Driving is not permitted for 2 weeks after surgery or your first follow-up visit with your surgeon. If you are taking prescription pain medications or narcotics, DO NOT DRIVE.
  • Sexual intercourse may be resumed as your comfort level permits.
  • People with sedentary jobs have returned to work as early as 2 weeks postoperatively. A physically demanding job may require 4 weeks before returning to work. This may be determined by you and your employer. Some people have residual fatigue several weeks after surgery.
  • It is common to feel a lump at the sites of the operation. This lump is a combination of normal fluid and scar tissue forming in this area. It usually goes away slowly over the first month or two following surgery.

Your bowel habits

You may have different bowel habits after your surgery. Loose stools are common for the first week or two after surgery. If you have watery diarrhea, call your surgeon. This may be a sign of a bowel infection. Severe constipation should be avoided. See the section below on medicines for constipation.

Your diet

There are generally no dietary restrictions following surgery. Avoid foods that cause diarrhea or digestive discomfort. You will eventually be able to resume your regular diet. A dietary supplement or drink can be used.


Your medicines: Take the medicines you were taking before surgery, unless your surgeon has made a change.

  • For pain

Your surgeon will order a prescription pain medicine for you after surgery. As your pain lessens, over the counter pain medicines such as acetaminophen or ibuprofen can be used. They can also be used instead of your prescription for mild pain.

  • For constipation

Prescription pain medicines can cause constipation. Your doctor may order a stool softener to prevent this. You should be back to your normal bowel routine in about 2 weeks. If the stool softener does not work, take Milk of Magnesia. If you still are not getting relief, call your surgeon.

Call your surgeon right away if you have:

  • Diarrhea that lasts more than three days
  • Nausea and vomiting that will not go away
  • Pain in your abdomen that gets worse or isn’t eased by the pain medicine
  • Pus drainage or redness around your incision
  • Fever with a temperature of 100.5 or higher


Follow-up after surgery is extremely important and our surgeons at Salus are committed to providing all the post surgical care you need. In order to identify and treat any complications as they may arise, close, lifetime follow-up is essential.