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Asian Healthcare Specialist
Asian Healthcare Specialist

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+65‎ 6334‎ 1486
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Robotic Radical Prostatectomy (RRP) in Singapore

Being diagnosed with prostate cancer can understandably cause significant concern about your health and future quality of life. Robotic radical prostatectomy (RRP) is an established surgical option for treating localised prostate cancer, involving the removal of the prostate gland and the seminal vesicles while aiming to preserve critical surrounding structures. This minimally invasive approach utilises robotic-assisted technology to perform the surgery through small incisions, which may reduce recovery time compared to traditional open surgery. At our clinic, Dr Azhari can provide comprehensive care throughout your treatment journey, from initial consultation through recovery and follow-up.

Dr. Nor Azhari Bin Mohd Zam
Dr. Nor Azhari Bin Mohd Zam

MBBS (NUS)|MRCS (Edin.)|MMed Surgery (NUS)|FAMS (Urology)

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low angle of an experienced male doctor working 2025 03 08 07 21 21 utc Robotic Radical Prostatectomy (RRP) in Singapore
Suitability Techniques Process Recovery Benefits Risks Cost FAQ Conclusion
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Suitability
Techniques
Process
Recovery
Benefits
Risks
Cost
FAQ
Conclusion

What is Robotic Radical Prostatectomy?

RRP is a minimally invasive surgical procedure to remove the entire prostate gland and some surrounding tissue in patients with prostate cancer. The surgery uses a robotic surgical system that translates the urologist’s hand movements into precise micro-movements of surgical instruments inside the patient’s body. The urologist operates from a console, viewing a magnified, three-dimensional image of the surgical site whilst controlling robotic arms equipped with surgical instruments.

This procedure treats clinically localised prostate cancer, meaning cancer that hasn’t spread beyond the prostate gland. The robotic system may enhance the surgeon’s capabilities through improved visualisation, precision, and dexterity in the confined space of the pelvis.

During RRP, the urologist removes the prostate gland and seminal vesicles, and may also remove nearby lymph nodes for examination. The procedure aims to eliminate cancer whilst preserving nerves responsible for erectile function and the sphincter muscles that control urinary continence when possible.

Robotic radical prostatectomy can help achieve cancer control in appropriately selected patients. The minimally invasive nature of the procedure may result in less blood loss, reduced post-operative pain, and shorter hospital stays compared to open surgery.

Who is a Suitable Candidate?

Ideal Candidates

Ideal Candidates

  • Men diagnosed with clinically localised prostate cancer (stages T1-T2)
  • Patients with intermediate to high-risk prostate cancer confined to the gland
  • Life expectancy of at least 10 years, making long-term cancer control beneficial
  • Good overall health status to tolerate general anaesthesia and surgery
  • Prostate size and anatomy suitable for robotic approach
  • Patients seeking definitive treatment rather than active surveillance
  • Those who have thoroughly discussed treatment options with their urologist
Contraindications

Contraindications

  • Extensive previous abdominal or pelvic surgery that may cause significant scarring
  • Severe cardiac or pulmonary conditions that preclude general anaesthesia
  • Uncorrectable bleeding disorders or coagulopathy
  • Active urinary tract infection requiring treatment before surgery
  • Morbid obesity that may limit robotic instrument access
  • Previous pelvic radiation that may complicate surgical dissection
  • Evidence of metastatic disease beyond the pelvis

The decision for robotic radical prostatectomy requires careful evaluation by an experienced urologist. Your urologist may review your prostate biopsy results, imaging studies, PSA levels, and overall health to determine whether RRP is appropriate for your specific situation. A thorough discussion of all treatment options, including radiation therapy and active surveillance, can help you make an informed decision aligned with your values and treatment goals.

Treatment Techniques & Approaches

  • Transperitoneal Robotic Approach

    The transperitoneal approach is a commonly performed technique for robotic radical prostatectomy. The urologist creates small incisions in the abdomen and enters the peritoneal cavity to access the prostate. This approach provides visualisation of pelvic anatomy and allows for lymph node dissection when indicated. The urologist can identify and preserve the neurovascular bundles responsible for erectile function when cancer location permits.

  • Extraperitoneal Robotic Approach

    The extraperitoneal technique involves accessing the prostate without entering the peritoneal cavity. This approach may be considered in patients with extensive previous abdominal surgery or those at risk for bowel complications. The urologist creates a working space outside the peritoneum, potentially reducing the risk of bowel injury and post-operative ileus. Some surgeons find this approach provides direct access to the prostate.

  • Nerve-Sparing Modifications

    When cancer characteristics allow, surgeons may employ nerve-sparing techniques to preserve the neurovascular bundles running alongside the prostate. Bilateral nerve-sparing preserves bundles on both sides, while unilateral sparing preserves one side when cancer is present near the opposite bundle. The decision depends on cancer location, stage, and pre-operative erectile function.

  • Technology & Equipment Used

    The robotic surgical system consists of a urologist console, a patient-side cart with robotic arms, and a vision system that provides high-definition, three-dimensional visualisation. The system filters hand tremor and scales movements for precision. Specialised instruments include monopolar and bipolar energy devices for tissue dissection and haemostasis. Imaging integration allows real-time ultrasound guidance when needed.

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The Treatment Process

Pre-Treatment Preparation

Patients undergo a comprehensive pre-operative assessment, including blood tests, cardiac evaluation, and anaesthesia consultation. Patients may need to stop blood-thinning medications as directed by their surgeon, typically one week before surgery. Bowel preparation with enemas or laxatives helps clear the intestines. A clear liquid diet begins the day before surgery, with nothing by mouth after midnight.

Arrange for someone to drive you home after discharge and assist during initial recovery. Prepare your home with necessary supplies, including comfortable clothing, stool softeners, and prescribed medications. Pre-operative teaching covers breathing exercises, leg exercises to prevent blood clots, and catheter care instructions.

During the Procedure

The procedure begins with the administration of general anaesthesia and the patient being positioned in the steep Trendelenburg position (head down, feet up). The urologist creates 5-6 small incisions (8-12mm) in the abdomen for robotic instrument placement. Carbon dioxide gas inflates the abdomen, creating space for the working space.

The urologist sits at the console, controlling robotic instruments, whilst the bedside assistant assists with instrument exchanges and specimen removal. The procedure involves careful dissection around the prostate, preservation of surrounding structures when possible, and removal of the prostate and seminal vesicles. The bladder neck is then reconstructed and connected to the urethra (vesicourethral anastomosis). A urinary catheter is placed to allow healing of this connection. The procedure may take several hours, depending on complexity.

Immediate Post-Treatment

After surgery, patients recover in the post-anaesthesia care unit with vital sign monitoring. Pain management includes medications administered intravenously or orally. Patients can begin clear liquids within hours and advance to a regular diet as tolerated. Early mobilisation starts the evening of surgery or the next morning to prevent complications.

The urinary catheter drains urine whilst the surgical connection heals. Patients learn catheter care and receive supplies for home management. Hospital discharge may occur within a few days after surgery, once pain is controlled with oral medications and patients are walking independently.

Recovery & Aftercare

First 24-48 Hours

Initial recovery focuses on pain management, typically managed with oral medications. Some abdominal bloating and shoulder discomfort from residual gas may occur. Walking begins within hours of surgery, gradually increasing distance and frequency. Avoid heavy lifting, straining, or strenuous activity.

Monitor for warning signs, including fever, severe pain, excessive bleeding, or catheter blockage. The surgical incisions require minimal care and are covered with skin adhesive or small bandages. Maintain adequate hydration and use stool softeners to prevent constipation.

First Week

Daily activities gradually increase while avoiding lifting more than a specified weight limit as advised by your urologist. Shower normally but avoid soaking in baths. Continue prescribed medications, including antibiotics if prescribed. Some patients may experience bladder spasms around the catheter, which can be managed with antispasmodic medications.

A follow-up appointment typically occurs after the catheter is removed. A cystogram may confirm proper healing of the vesicourethral anastomosis before removal. Pathology results become available, providing critical information about cancer stage and the need for additional treatment.

Long-term Recovery

Urinary continence typically improves gradually over time. Pelvic floor exercises (Kegel exercises) may help strengthen the sphincter muscles and support recovery of continence. Continence recovery varies among individuals. Protective pads may be needed initially.

Erectile function recovery varies significantly depending on age, pre-operative function, and nerve-sparing success. Recovery timelines vary, with various treatments available to assist. Regular PSA monitoring begins to assess cancer control. Return to normal activities, including exercise and sexual activity, occurs as advised by your urologist. Individual results and timelines may vary.

Our urologists provide comprehensive post-procedure support to help with recovery.

Schedule your consultation to learn more about what to expect.

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Benefits of Robotic Radical Prostatectomy

Robotic radical prostatectomy is a minimally invasive surgical approach for treating localised prostate cancer. The procedure may reduce blood loss during surgery, thereby decreasing the need for transfusions. Smaller incisions may lead to reduced post-operative pain and decreased need for pain medications. Hospital stays can be shorter, with patients often discharged within a timeframe determined by their individual recovery.

The enhanced visualisation and precision of robotic surgery may help preserve essential structures. When nerve-sparing is possible, the magnified view can help identify and protect neurovascular bundles. The procedure aims to provide cancer treatment with complete gland removal and pathological staging.

Patients may experience a return to normal activities and work. The cosmetic outcome involves small scars rather than a large abdominal incision. The procedure can also allow simultaneous lymph node dissection for staging when indicated.

Risks & Potential Complications

Common Side Effects

Temporary urinary incontinence initially affects patients, gradually improving over time. Mild to moderate pain at incision sites may resolve within days to weeks. Bladder spasms around the catheter occur frequently but can respond to medication. Temporary scrotal or penile swelling may develop due to surgical positioning.

Erectile dysfunction can occur, with recovery varying based on multiple factors, including nerve-sparing success. Constipation from pain medications and reduced activity may require management with stool softeners. Fatigue during recovery is expected to improve progressively over time.

Rare Complications

Bleeding requiring transfusion can occur. Infections at surgical sites or in the urinary tract may affect patients. Injury to surrounding organs, including the rectum or bladder, is possible. The risk of deep vein thrombosis or pulmonary embolism can be minimised through early mobilisation and preventive measures.

Anastomotic leak or stricture at the bladder-urethra connection may require additional intervention. Lymphocele formation after lymph node dissection may need drainage. Hernias at port sites develop rarely but may require surgical repair.

Surgical teams employ established protocols and meticulous technique to minimise the risk of complications. Careful patient selection, thorough preoperative preparation, and attentive postoperative care contribute to better outcomes.

Cost Considerations

The cost of robotic radical prostatectomy varies based on several factors, including hospital facility fees, urologist fees, anaesthesia services, and length of hospital stay. The robotic technology and instruments contribute to procedure costs. Pre-operative investigations, pathology examination, and post-operative care are typically included in comprehensive treatment packages.

Additional considerations include potential costs for managing side effects or complications. Rehabilitation services, such as pelvic floor physiotherapy, may be beneficial for the recovery of continence. Patients may require medications or devices for erectile dysfunction management during recovery.

Quality of surgical care can impact both short-term recovery and long-term outcomes. Choosing an experienced surgical team familiar with robotic techniques may help with outcomes. During consultation, healthcare professionals can provide cost information specific to your treatment plan.

Frequently Asked Questions

How long does robotic radical prostatectomy surgery take to perform?

The surgical procedure may take between 2 and 4 hours, depending on factors including prostate size, patient anatomy, extent of nerve-sparing attempted, and whether lymph node dissection is performed. The urologist works methodically to aim for precise cancer removal while preserving important structures when possible. Additional time is needed for anaesthesia preparation and recovery room monitoring, resulting in a total hospital time longer than the actual surgery duration.

When can I return to work after robotic radical prostatectomy?

Patients with desk jobs may return to work within a few weeks after surgery, while those with physically demanding occupations may need more extended recovery periods. Many men prefer working from home initially while managing temporary urinary leakage. Your urologist can provide specific guidance based on your job requirements and recovery progress.

How effective is nerve-sparing during robotic prostatectomy?

Nerve-sparing success depends on cancer location, urologist experience, and pre-operative erectile function. When bilateral nerve-sparing is possible, erectile function recovery may occur in previously potent men, though recovery may take time. Unilateral nerve-sparing or non-nerve-sparing procedures have different recovery patterns. Your urologist can discuss realistic expectations based on your specific situation during consultation.

What happens if cancer is found at the surgical margins?

Positive surgical margins, where cancer cells extend to the edge of the removed tissue, can occur in some cases. This finding doesn’t necessarily mean cancer remains, as the surgical process may destroy remaining cells. Your urologist can closely monitor PSA levels and may recommend additional treatment, such as radiation therapy, if PSA levels rise. Each case is evaluated individually based on pathology findings and other risk factors.

How soon after surgery will I know if the cancer is completely removed?

Initial pathology results are typically available within a period after surgery, providing information about cancer stage, grade, and surgical margins. Long-term cancer control is monitored through PSA blood tests starting after surgery. An undetectable PSA level indicates successful cancer removal. Regular PSA monitoring continues long-term to detect any recurrence early when additional treatment would be most effective.

Can robotic prostatectomy be performed if I’ve had previous abdominal surgery?

Previous abdominal surgery doesn’t automatically exclude robotic prostatectomy but may increase technical difficulty due to scar tissue (adhesions). Your urologist can review your surgical history and may obtain imaging to assess the feasibility of the procedure. The extraperitoneal approach might be preferred in some cases. Experienced robotic surgeons can often navigate adhesions successfully, though operative time may be longer.

What activities should I avoid during recovery from RRP?

For the initial recovery period, avoid lifting heavy objects, strenuous exercise, and activities that increase abdominal pressure. Driving may be delayed until you’re off narcotic pain medications and can react quickly. Sexual activity typically resumes after a period determined by your surgeon. Bicycling may need to be avoided for a period to protect the surgical area. Swimming is not allowed until incisions are fully healed. Your urologist provides a specific timeline based on your recovery progress.

Conclusion

Robotic radical prostatectomy is an established surgical treatment for localised prostate cancer, combining cancer control with the potential advantages of minimally invasive surgery. The procedure’s precision and enhanced visualisation may help preserve continence and sexual function while aiming to achieve complete cancer removal. Understanding the treatment process, recovery expectations, and potential outcomes enables you to make an informed decision about your prostate cancer treatment.

Success with RRP depends significantly on surgical specialisation and appropriate patient selection.

Ready to Take the Next Step?

If you’re considering robotic radical prostatectomy, Dr Azhari can help you understand if it’s a suitable option for your needs.

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Dr. Nor Azhari Bin Mohd Zam

Dr. Nor Azhari Bin Mohd Zam

MBBS (NUS)|MRCS (Edin.)|MMed Surgery (NUS)|FAMS (Urology)

Former Director of Endourology (Urinary stone service) Singapore General Hospital 2016 to 2023

With more than 20 years experience as a certified Urologist, Dr Nor Azhari specializes in treating a wide range of kidney, bladder and prostate conditions as well as disorders of the male reproductive organs. He offers minimally invasive treatment options and provides same-day appointments for convenience.

  • Skilled urologist and kidney stone surgeon
  • Recognized with the College of Surgeons Gold Medal and Singapore Urological Association Book prize
  • Minimally invasive treatment options available (non-invasive and endoscopic/key-hole techniques)
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