RALP - Robotic-Assisted Laparoscopic Prostatectomy

What is a Robotic-Assisted Laparoscopic Prostatectomy (RALP)?

A robotic-assisted laparoscopic prostatectomy (RALP) is a minimally invasive surgical procedure used to remove the prostate gland in men with prostate cancer. The surgery is performed using advanced robotic technology, allowing the surgeon to operate with greater precision and control. RALP has become a popular option due to its smaller incisions, reduced recovery time, and lower risk of complications compared to traditional open surgery. RALP is typically recommended when prostate cancer is localised and surgery is the best treatment option. The procedure helps to remove cancerous tissue and minimise the risk of the cancer spreading.

When is RALP is recommended?

Prostate cancer is one of the most common cancers in men, particularly as they age. Early detection and treatment are essential to prevent the cancer from spreading. When prostate cancer is confined to the prostate, RALP (robot-assisted laparoscopic prostatectomy) may be recommended as a surgical option to remove the prostate and surrounding tissues.

RALP may be considered for patients who:

• Have been diagnosed with localized prostate cancer (cancer contained within the prostate).
• Have been advised that surgery is the optimal approach for removing the cancerous tissue.
• Are in good overall health and suitable candidates for surgery.

As a minimally invasive treatment option for prostate cancer, RALP can help reduce the long-term risks associated with untreated or advanced cancer.

What does the procedure involve?

During a Robotic-Assisted Laparoscopic Prostatectomy (RALP), the patient is placed under general anesthesia to ensure they remain asleep and pain-free throughout the procedure. The surgeon operates a robotic system to manipulate small surgical instruments inserted through several small incisions in the patient’s abdomen. This approach enables the precise removal of the prostate and surrounding affected tissues, with minimal impact on nearby structures. The robotic system enhances precision and dexterity, allowing the surgeon to navigate around delicate areas such as nerves controlling erectile function and urinary continence. The procedure generally lasts 2 to 4 hours, depending on the case's complexity. After the prostate is removed, a catheter is typically placed in the bladder to drain urine during the healing process. Hospital stays usually last between 1 to 2 nights after surgery.

What are the potential risks and complications?

Like all surgeries, RALP carries certain risks, though it is generally considered a safe and effective procedure. Possible risks and complications include:

• Infection: There is a small risk of infection at the surgical site or in the urinary tract.
• Bleeding: While rare, some patients may experience bleeding during or after the procedure.
• Urinary incontinence: Temporary loss of bladder control is common after prostate surgery, but it typically improves over time.
• Erectile dysfunction: Although nerve-sparing techniques can help reduce this risk, erectile dysfunction may still occur, either temporarily or permanently.
• Blood clots: There is a small risk of blood clots forming in the legs or lungs following surgery.

The surgeon will discuss these risks in detail before the procedure and provide guidance on how to minimize the chance of complications.

After the procedure

Recovery after RALP is generally quicker than with traditional open surgery. Most patients can return to light activities within 2 to 3 weeks and resume normal daily tasks, including work, within 4 to 6 weeks.

In the first few days following surgery, patients may experience some discomfort and may require pain relief, though this usually improves as healing progresses. It is essential to avoid heavy lifting, vigorous exercise, and any activities that strain the abdomen during the recovery period. The doctor will provide specific guidelines on when certain activities can be safely resumed.

The catheter placed during the procedure typically remains in place for 1 to 2 weeks and is removed during a follow-up appointment. Some urinary incontinence may occur, but this often improves over time with pelvic floor exercises.

RALP offers excellent long-term outcomes for men with prostate cancer. Most patients experience significant improvements in cancer control, urinary function, and overall quality of life following the surgery. Although temporary side effects, such as urinary incontinence and erectile dysfunction, are common, they generally improve over time with appropriate follow-up care and rehabilitation exercises.