If you have been diagnosed with prostate cancer and surgery has been recommended, you may have heard about both robotic prostatectomy and traditional open surgery.
Both procedures are used to remove the prostate as part of a radical prostatectomy. The main difference is how the surgeon reaches the prostate.
Robotic-assisted radical prostatectomy uses keyhole surgery, with the surgeon controlling specialised instruments from a console. Open radical prostatectomy involves a larger incision in the lower abdomen through which the surgeon performs the operation directly.
Questions patients as are: How do robotic and open prostate surgery compare? And does the surgical approach affect your recovery or cancer outcomes?
What is a radical prostatectomy?
A radical prostatectomy is an operation to remove the prostate gland and seminal vesicles. Nearby lymph nodes may also be removed depending on the characteristics and stage of the cancer.
Radical prostatectomy can be performed using an open, laparoscopic or robotic-assisted approach.
The aim of the operation is the same regardless of the approach: to remove the prostate containing the cancer while preserving urinary continence and, where it is safe and technically possible, the nerves involved in erectile function.
Whether surgery is appropriate depends on factors including your cancer stage, biopsy results, overall health and individual circumstances. NICE recommends radical prostatectomy as one of the treatment options for appropriate men with localised and locally advanced prostate cancer.
What is robotic prostate surgery?
Robotic-assisted radical prostatectomy (RARP) is a minimally invasive form of prostate surgery.
Instead of making one larger abdominal incision, the surgeon makes several small incisions. A camera provides a magnified, three-dimensional view of the operating area and specialised instruments are controlled by the surgeon from a console.
Importantly, the robot does not perform the operation independently. The surgeon controls every movement of the robotic instruments.
The technology is designed to provide precise movements and detailed visualisation in the confined space of the pelvis.
What is open prostate surgery?
Open radical prostatectomy is the traditional surgical approach.
The surgeon makes a single larger incision in the lower abdomen to access and remove the prostate.
Open surgery remains an established treatment option and can be appropriate in certain circumstances. However, robotic-assisted surgery has become increasingly common for radical prostatectomy.
The surgical approach is only one part of the decision. The surgeon’s experience, the hospital’s experience with the procedure and the individual patient’s cancer and anatomy all need to be considered.
Robotic surgery vs open surgery: the key differences
Research comparing robotic and open prostate surgery has found some differences in how patients recover. A 2026 review of the current available evidence, found that patients having robotic surgery generally had less blood loss, were less likely to need a blood transfusion, spent less time in hospital and experienced fewer complications after surgery.
Does robotic surgery remove the cancer more effectively?
This is one of the most important questions patients understandably ask.
The purpose of both robotic and open radical prostatectomy is to remove the prostate containing the cancer. The robotic system itself does not make the operation a different cancer treatment.
Current evidence suggests that robotic and open surgery can provide comparable cancer control when performed appropriately. Studies comparing the two approaches have generally found similar rates of positive surgical margins.
The most appropriate surgical approach therefore needs to take account of the individual cancer, rather than choosing a technique based on the technology alone.
Is recovery faster after robotic prostate surgery?
One of the clearest differences between the two approaches is recovery.
Because robotic surgery uses several small incisions rather than one larger incision, there is generally less tissue disruption. This can mean:
- Less blood loss during surgery
- A lower likelihood of needing a blood transfusion
- Less post surgery discomfort
- A shorter hospital stay
- A quicker return to normal activities
A recent review found that hospital stay was, on average, around 1.4 days shorter following robotic-assisted surgery compared with open radical prostatectomy.
However, recovery varies from person to person. Your general health, age, fitness, the complexity of the surgery and your individual recovery all have an influence.
What about urinary continence and erectile function?
Urinary continence and erectile function are two of the biggest concerns for men considering prostate cancer surgery.
The nerves responsible for erections run very close to the prostate. Where it is safe to do so from a cancer perspective, nerve-sparing surgery may be considered to preserve these structures.
The likelihood of recovering urinary control and erectile function depends on several factors, including your pre-operative function, age, cancer characteristics, whether nerve-sparing surgery is appropriate and the experience of the surgical team.
Surgical experience can be particularly important when trying to preserve the structures involved in continence and erectile function. Nerve-sparing surgery is technically demanding, and an experienced surgeon will assess the location and extent of the cancer before deciding whether nerve-sparing is appropriate. Read more about how surgeon experience can affect prostate cancer surgery and recovery outcomes.
Some studies have found that men undergoing robotic surgery may experience earlier recovery of urinary continence and erectile function. However, results vary between studies, so these outcomes cannot be guaranteed and will depend on the individual.
This is why it is important to discuss your expected outcomes with your surgeon rather than relying on a single average figure.
Does the surgeon’s experience matter?
Yes.Robotic technology is an important part of the operation, but the robot does not replace the surgeon’s skill or experience.
Radical prostatectomy is technically demanding surgery performed in a complex anatomical area. Experience with the procedure can influence surgical technique, decision-making and the management of complications.
When discussing surgery, it can be useful to ask:
- How many radical prostatectomies does the surgeon perform?
- How often does the surgeon perform robotic prostatectomy?
- What are the team’s outcomes for urinary continence?
- What are the team’s erectile function outcomes?
- What is the positive surgical margin rate?
- What enhanced recovery support is available after surgery?
- What other treatment options are available in my particular case?
These questions can help you understand the experience and support available at the centre where your surgery would take place.
Robotic vs open prostatectomy: which is right for me?
There is no single surgical approach that is right for every man. The decision will depend on your cancer, your overall health and your individual circumstances.
Robotic-assisted surgery can offer advantages such as less blood loss, a shorter hospital stay and a quicker recovery, while open radical prostatectomy remains an established treatment option.
Your urologist can discuss the potential benefits and risks of each approach with you, including how surgery may affect urinary continence, erectile function and cancer control.
Robotic prostate surgery in Sussex
Dr Edward Calleja is a Consultant Urological Surgeon specialising in robotic prostatectomy and radical prostatectomy for prostate cancer.
He provides treatment for NHS and private patients and uses a personalised approach to prostate cancer surgery, including nerve-sparing techniques where appropriate.
If you have been diagnosed with prostate cancer and are considering surgery, a consultation can provide an opportunity to discuss whether radical prostatectomy is suitable for you and which surgical approach may be appropriate for your individual circumstances.
The right surgical approach is ultimately an individual decision based on your cancer, your health and your treatment goals.