Clinically reviewed by
Mr Paul Cathcart
Consultant Urological Surgeon & Robotic Prostate Cancer Specialist · Reviewed June 2026 · Review due June 2027
What is a Robotic Prostatectomy?
A robotic prostatectomy — also known as robotic-assisted laparoscopic prostatectomy (RALP) — is a minimally invasive operation to remove the prostate gland and the surrounding seminal vesicles, performed using the Da Vinci® surgical system. It is the most widely performed approach to radical prostatectomy for localised and selected locally advanced prostate cancer.
The surgeon operates from a console a few feet from the patient, controlling four robotic arms that hold a 3D high-definition camera and wristed instruments. Hand and finger movements at the console are translated into precise, tremor-filtered motion inside the body through a small number of keyhole incisions. The robot does not act independently — every movement is directed by the surgeon.
Compared with traditional open prostatectomy, the robotic approach generally allows for less blood loss, a shorter hospital stay, faster recovery, and more precise dissection around the nerves responsible for continence and erectile function.
Who Is It For?
Robotic prostatectomy is offered to men with localised or selected locally advanced prostate cancer who are fit for surgery. Suitability is decided after a full assessment and discussion at our multidisciplinary team (MDT) meeting.
Localised Prostate Cancer
Cancer that is contained within the prostate gland and where surgery offers the best balance of cure and functional preservation.
Find out more →Locally Advanced Disease (selected)
Cancer extending just beyond the prostate capsule in carefully selected patients, often as part of a multimodal treatment plan.
Find out more →Salvage Prostatectomy
Removal of the prostate after recurrence following radiotherapy or focal therapy — a technically demanding procedure best performed by high-volume surgeons.
Find out more →Patients Prioritising Recovery
Men who would benefit from the smaller incisions, reduced blood loss and shorter hospital stay associated with the robotic approach.
Find out more →How Robotic Prostatectomy Works
The operation is performed under general anaesthetic and usually takes two to three hours. Five small (8–12 mm) keyhole incisions are made across the lower abdomen to admit the robotic arms and a small assistant port.
Through these ports, the prostate is carefully separated from the bladder above, the urethra below, and the surrounding tissues that contain the neurovascular bundles — the small nerves and vessels responsible for erectile function. Where it is oncologically safe to do so, these bundles are preserved (nerve-sparing surgery), giving the best chance of recovering erectile function.
The prostate and seminal vesicles are removed together. The bladder is then reconnected to the urethra in a watertight join (vesico-urethral anastomosis), and a urinary catheter is left in place for around seven to ten days to allow the join to heal.
Depending on the cancer staging, the pelvic lymph nodes may also be removed at the same time (pelvic lymph node dissection) so they can be examined for any spread of disease.
Preparation & Surgery
Every robotic prostatectomy is preceded by a thorough work-up and personalised surgical plan. On the day of surgery the operation is carried out in a dedicated robotic theatre.
Pre-Operative Work-Up
Multiparametric MRI, prostate biopsy results and staging scans are reviewed at our prostate cancer multidisciplinary team meeting to confirm that surgery is the right option.
You meet your surgeon and anaesthetist before the day of surgery to discuss the nerve-sparing approach, expected outcomes for cancer control, continence and erectile function, and any individual considerations.
Pelvic floor exercises are usually started a few weeks before surgery to support continence recovery afterwards.
Day of Surgery
The procedure is performed under general anaesthetic and usually takes 2–3 hours. Five small keyhole incisions are made across the lower abdomen, the Da Vinci robot is docked, and the prostate is removed with millimetre precision under 3D HD vision.
Where oncologically safe, the neurovascular bundles are preserved to support recovery of erectile function. The bladder is then reconnected to the urethra and a catheter left in place for 7–10 days.
Most patients are discharged home the day after surgery with personalised advice on recovery and pelvic floor rehabilitation.
The Da Vinci® Surgical System
The Global Standard in Robotic Surgery
London Urology Specialists performs robotic prostatectomy using the Da Vinci® surgical system, manufactured by Intuitive Surgical. First introduced in the year 2000, the Da Vinci system is the most widely used surgical robot in the world, with over 14 million procedures performed across more than 70 countries. It has become the established platform for radical prostatectomy.
3D HD Vision
Twin high-definition cameras provide a stereoscopic, magnified view of the surgical field — up to 10× magnification with true depth perception.
- • True 3D depth perception
- • Up to 10× magnification
- • Clear visualisation of nerves and vessels
EndoWrist® Instruments
Wristed instruments with seven degrees of motion — a greater range than the human hand — with built-in tremor filtering for fine, controlled movement.
- • Seven degrees of freedom
- • Tremor filtering and motion scaling
- • Precise dissection around delicate structures
Key features of the Da Vinci® system
- ✓ Surgeon-controlled console — the robot never moves independently
- ✓ 3D HD stereoscopic vision with up to 10× magnification
- ✓ Wristed EndoWrist® instruments with seven degrees of motion
- ✓ Motion scaling and tremor filtering for fine control
- ✓ Smaller incisions, generally less blood loss, faster recovery
- ✓ Used worldwide as the standard platform for radical prostatectomy
A note on robotic surgery: The Da Vinci® system is a sophisticated tool, but the quality of any robotic prostatectomy ultimately depends on the experience of the surgeon at the console. Outcomes improve significantly with surgical volume.
High surgical volume is consistently linked to better outcomes in robotic prostatectomy — for cancer control, urinary continence and recovery of erectile function. Our two consultant robotic surgeons bring decades of combined experience to every case.
2,000+
Career robotic prostatectomies performed by Mr Cathcart, with around 200 each year — among the highest-volume robotic prostate surgeons in the UK
2007
Mr Khoubehi began performing robotic radical prostatectomies in 2007 — one of the earliest adopters of robotic prostate surgery in the United Kingdom
NeuroSAFE — Real-Time Nerve-Sparing Pathology
Offered by Mr Paul Cathcart at London Urology Specialists
NeuroSAFE (Neurovascular Structure-Adjacent Frozen-section Examination) is an advanced intra-operative pathology technique used during robotic prostatectomy. It was developed at the Martini-Klinik in Hamburg — the world's largest prostate cancer centre — and is offered in only a small number of UK practices.
During surgery, the back surface of the prostate — immediately next to the neurovascular bundles that control erectile function — is sampled and analysed in real time by a specialist pathologist. The surgeon can therefore safely attempt maximal nerve-sparing and, if any cancer cells are detected at the edge of the specimen, immediately remove a thin extra layer of tissue on that side to secure clear margins.
Better Cancer Control
Real-time confirmation of clear margins around the prostate, with immediate secondary resection if any cancer cells are seen at the edge of the specimen. Positive surgical margins are reduced.
Better Functional Recovery
Confidence to attempt maximal nerve-sparing in cases that might otherwise have required wider resection. Higher rates of nerve-sparing surgery support better long-term continence and erectile function.
Why NeuroSAFE matters
- ✓ Real-time pathology during your operation — no waiting days for results
- ✓ Supports maximal nerve-sparing where safe to do so
- ✓ Immediate secondary resection if margins are positive
- ✓ Evidence-based — supported by the UK NeuroSAFE PROOF trial
- ✓ Developed at Martini-Klinik, the world's largest prostate cancer centre
- ✓ Offered at only a small number of UK robotic centres
Note on availability: NeuroSAFE is offered as part of robotic prostatectomy with Mr Paul Cathcart at London Urology Specialists. Suitability is discussed individually at consultation as part of your overall surgical plan.
What to Expect
From your first consultation through to long-term follow-up, our pathway is structured around precise diagnosis, careful surgical planning, and high-touch recovery support.
1. Consultation & Assessment
Detailed consultation, review of your MRI, biopsy and PSA results, examination, and shared decision-making about whether robotic prostatectomy is the right option for you.
2. MDT Discussion
Your case is reviewed at our prostate cancer multidisciplinary team meeting alongside specialist radiologists, oncologists and pathologists to confirm the surgical plan.
3. Pre-Operative Preparation
Pre-assessment with anaesthetics, blood tests, optimisation of any other health conditions, and pelvic floor exercises started in the weeks leading up to surgery.
4. Robotic Surgery
Da Vinci robotic prostatectomy under general anaesthetic, lasting around 2–3 hours. Most patients are discharged the day after surgery.
5. Catheter & Early Recovery
A urinary catheter remains in place for 7–10 days and is removed in clinic. Pelvic floor exercises continue to support continence recovery.
6. Histology & PSA Review
The pathology report from the removed prostate is reviewed together at follow-up, alongside your first post-operative PSA blood test at around 6 weeks.
7. Long-Term Follow-Up
Regular PSA monitoring and clinical review continue long-term, with ongoing support for any continence or sexual function recovery as needed.
Recovery & Functional Outcomes
Recovery from robotic prostatectomy is typically faster than open surgery, with most men back to normal activity within a few weeks. Functional recovery — continence and erectile function — takes longer and is supported by individualised rehabilitation.
- ✓Hospital stay: Most patients are discharged the day after surgery.
- ✓Catheter: A urinary catheter remains in place for 7–10 days and is removed in clinic.
- ✓Daily activity: Light walking from day one; driving and office work generally at 2–3 weeks; full physical activity at 4–6 weeks.
- ✓Continence: Some leakage is normal immediately after the catheter is removed. Around 90–95% of men regain good urinary control within 12 months, with most improvement in the first 3–6 months.
- ✓Erectile function: Recovery depends on age, pre-operative function and whether nerve-sparing was possible. Penile rehabilitation with PDE5 inhibitors is started early; full recovery can take 12–24 months.
- ✓PSA monitoring: Your first post-operative PSA is checked at around 6 weeks, then at regular intervals long-term to confirm cancer control.
Benefits & Considerations
Benefits
- ✓Minimally invasive — five small keyhole incisions rather than a large open wound
- ✓Generally less blood loss and rarely a need for transfusion
- ✓Shorter hospital stay — typically one night
- ✓Faster recovery and return to normal activity
- ✓Precise nerve-sparing where oncologically safe, supporting continence and erectile recovery
- ✓Excellent long-term cancer control when performed by a high-volume surgeon
Considerations
- !Major surgery under general anaesthetic with the usual surgical risks (bleeding, infection, blood clots)
- !Temporary urinary incontinence after catheter removal is normal and improves over weeks to months
- !Erectile function recovery can be slow, may be partial, and depends on nerve-sparing and pre-op function
- !Loss of ejaculation — the seminal vesicles are removed, so men become infertile after surgery
- !Some patients require additional treatment after surgery if histology shows higher-risk disease
- !Outcomes depend heavily on surgical volume — choose a high-volume robotic surgeon
Frequently Asked Questions
Meet your Specialists
Robotic prostatectomy at London Urology Specialists is performed by consultant urological surgeons with world-class outcomes for cancer control, continence and erectile function recovery.
