Best Options for Prostate Surgery: Traditional versus Robot-Assisted Procedures

A diagnosis of prostate cancer that hasn’t spread comes with treatment options such as watchful waiting, hormone therapy, and radiation. But if your doctor recommends prostate removal, you have one very important decision: trust your surgery to human hands or to robotic arms controlled by your surgeon. A study led by researchers at Harvard-affiliated Massachusetts General Hospital (MGH) and published in the “Journal of Clinical Oncology” found little difference in the outcomes. “Yes, the two are basically the same in outcomes,” says Dr. William DeWolf, professor of surgery at Harvard Medical School and urologist-in-chief at Beth Israel Deaconess Medical Center. “I don’t see any difference between the two, nor should there be, based on technique.”

Surgeries and outcomes

Researchers looked at the two most common methods of radical prostatectomy (removal of the prostate and nearby tissue, such as lymph nodes). During robot-assisted radical prostatectomy, the surgeon sits at a console and controls robotic arms that have long, thin, laparoscopic-type instruments. Small keyhole incisions are made across the abdomen, and the prostate is removed in its entirety. The surgery typically lasts about four hours.

In contrast, during traditional open radical prostatectomy, the surgeon holds the instruments in his or her own hands, makes a four-inch incision in the abdomen, and then removes the prostate. It lasts about two hours.

Researchers found no significant differences in side effects for either surgery. Overall, about 88% of men in the study had trouble with sexual function and about 31% had incontinence following surgery. The study didn’t look at other side effects, but Dr. DeWolf says pain and infection risk are the same for both procedures. Importantly, he says, both procedures remove cancer effectively.

Which is right for you

While traditional open surgery usually doesn’t require blood transfusions, Dr. DeWolf says robot-assisted surgery has less blood loss.

“So the procedure is better for men who are on aspirin therapy due to a heart condition or a history of stroke,” he explains. The small incisions of robotic surgery also allow for a slightly faster recovery, enabling men to get back to heavy lifting in one or two weeks.

However, Dr. DeWolf says, robot-assisted surgery doesn’t work well for men who have a large prostate or abdominal scarring from previous surgeries. Traditional open surgery is better in those cases, as well as for men whose cancer may have begun to spread, which requires some exploration.

And when it comes to finding a surgeon, Dr. DeWolf recommends asking about expertise, not methodology.

“It’s the person doing it, not the equipment. How many surgeries has he performed? Go to the doctor who’s done the most and you’ll get the job done,” he says

The information found here is not intended to provide nor should it be interpreted to provide professional medical, legal or financial advice. You should consult a trained professional for more information.Excerpted from Harvard Mental Health Letter (September 2012) © (2012), Harvard University. For more information visit:

Harvard Health Publications does not endorse any products or medical procedures.

Category: Experts Speak

Tags: CancerForward, CancerForward Expert Article, Dr. William DeWolf, incontinence, Journal of Clinical Oncology, Massachusetts General Hospital, Prostate Surgery, robot-assisted radical prostatectomy, sexual function, traditional open radical prostatectomy