Dr. Amit Goel

Menu
Menu

Nerve and Continence preserving Robotic Radical Prostatectomy for Cancer Prostate

Overview
  • A cutting-edge, minimally invasive robotic surgery performed to remove the prostate gland affected by cancer.

  • Uses the da Vinci Robotic System for superior precision, stability, and 3D magnification.

  • Designed to achieve complete cancer removal while protecting:

    • Neurovascular bundles (responsible for erections)

    • Sphincter muscles (responsible for urinary control)

    • Pelvic floor support structures

  • Gold-standard treatment for localized early-stage prostate cancer.

Nerve Preservation

  • Targeted protection of the penile neurovascular bundles that control erectile function.
  • Helps maintain natural erections post-surgery.
  • Performed as:

    • Bilateral nerve-sparing
    • Unilateral nerve-sparing
    • Partial nerve-sparing—based on cancer involvement.

Continence Preservation

  • Focused on maintaining urinary control mechanisms by preserving:

    • External urinary sphincter
    • Bladder neck
    • Supportive pelvic structures
    • Distal urethra length

  • Uses special reconstructive techniques to enable faster return to continence.
  • Localised prostate cancer (Stage T1–T2).
  • Patients with:

    • Rising PSA levels
    • Cancer found in biopsy
    • MRI showing organ-confined disease
    • Good sexual function pre-surgery
    • Suitable for men seeking functional preservation along with cancer cure.

 

  • Detailed clinical examination.
  • PSA monitoring.
  • MRI prostate for mapping cancer location and nerve involvement.
  • Complete blood tests and fitness evaluation.
  • Counselling regarding:

    • Fertility
    • Sexual function outcomes
    • Continence recovery timeline

  • Prehabilitation:

    • Pelvic floor exercises
    • Diet and lifestyle modifications

Technical Advantages

  • 10x magnified HD 3D vision
  • Enhanced dexterity with wristed robotic instruments
  • Tremor-free surgical movements
  • Better access to deep pelvic areas

Clinical Advantages

  • Less blood loss
  • Fewer complications
  • Minimal tissue trauma
  • Smaller scars
  • Shorter hospital stay

Functional Advantages

  • Higher success in nerve preservation
  • Earlier urinary continence
  • Better chances of sexual function recovery
  • Faster return to regular activities
  1. Patient Positioning & Anaesthesia
  • Procedure performed under general anaesthesia.
  • Patient placed in steep Trendelenburg position for optimal pelvic access.

2. Port Placement

  • 5–6 small incisions (8–12 mm) created for robotic arms and camera ports.
  • Abdominal cavity inflated with CO₂ to provide working space.

3. Robotic Docking

  • da Vinci robot is docked to the surgical ports.
  • Surgeon controls the console from a separate unit.

4. Dissection Phase

  • Precise separation of prostate from surrounding tissues.
  • Identification of key structures:

    • Bladder neck
    • Seminal vesicles
    • Neurovascular bundles
  • Urethral sphincter

5. Nerve – Sparing Stand

  • Gentle, atraumatic dissection of nerves from the prostate capsule.
  • Energy sources used minimally to avoid thermal injury.
  • Nerve bundles left intact as much as possible.

6. Continence-Sparing Reconstruction

  • Bladder neck preservation (whenever anatomically safe).
  • Reconstruction of posterior musculofascial support (Rocco stitch).
  • Preservation of maximum sphincter length.
  • Vesicourethral anastomosis—precision suturing connecting bladder to urethra.

7. Prostate Removal

  • Prostate placed in an endobag and removed via one port.
  • Lymph nodes removed if indicated (extended pelvic lymph node dissection).

8. Completion

  • Ports removed; incisions closed with minimal sutures.
  • Foley catheter placed for temporary urinary drainage.

Hospital Stay

  • Usually discharged in 24–48 hours.

Catheter Management

Catheter removed after 7–10 days following healing confirmation.

Pain & Mobility

  • Minimal pain due to small incisions.
  • Early mobilization encouraged from Day 1.

Diet

  • Clear liquids on the same day; soft diet next morning.

Activity

  • Return to office work in 2–3 weeks.
  • Heavy lifting avoided for 4–6 weeks.

Cancer Control

  • High cancer cure rate with negative surgical margins.
  • Accurate removal of cancerous tissues.

Urinary Continence

  • Majority regain continence within:

    • 1–2 weeks (early responders)
    • 6–12 weeks (typical)
    • 3–6 months (delayed responders)

  • Continence preservation techniques improve outcomes significantly.

Sexual Function

  • Recovery timeline depends on:

    • Age
    • Preoperative sexual function
    • Grade of nerve-sparing

  • Robotic nerve-sparing increases chances of recovering natural erections.
  • Temporary urinary leakage
  • Erectile dysfunction (varies per patient)
  • Rare injury to rectum or surrounding tissues
  • Infection or bleeding
  • Scar tissue formation causing narrowing (stricture)
  • Lymphocele formation after lymph node removal
  • Very rare: blood clots, anaesthesia-related issues

  • Temporary urinary leakage
  • Erectile dysfunction (varies per patient)
  • Rare injury to rectum or surrounding tissues
  • Infection or bleeding
  • Scar tissue formation causing narrowing (stricture)
  • Lymphocele formation after lymph node removal
  • Very rare: blood clots, anaesthesia-related issues

If you or a loved one needs a kidney transplant, consult Dr. Amit Goel, a trusted Urologist & Kidney Transplant Specialist, to discuss robotic or open transplant options and donor procedures.

 

📍 C2/902, Parsvnath Exotica, DLF Phase 5, Sector 53, Gurugram, Haryana 122003  

 

📞 +91 84470 18167

Scroll to Top