Robotic Prostatectomy in Singapore | Prostate Cancer Treatment

Robotic prostatectomy in Singapore, formally known as robot-assisted laparoscopic radical prostatectomy (RALRP), is a minimally invasive surgical procedure to remove the entire prostate gland and some surrounding tissue. The surgery is performed using a robotic surgical system that translates the surgeon’s hand movements into precise micro-movements of surgical instruments inside the body.

During this procedure, the MOH-accredited urologist operates from a console, controlling robotic arms equipped with surgical instruments and a high-definition 3D camera. This approach allows for removal of cancerous tissue through several small incisions rather than one large opening. The primary goal is complete cancer removal whilst preserving important structures like the nerves controlling erection and the urinary sphincter that maintains continence.

The robotic system provides magnified visualisation up to 10 times normal vision and instruments with greater range of motion than the human wrist. This enhanced capability enables meticulous dissection around delicate structures, potentially improving functional outcomes whilst maintaining cancer control.

Ideal Candidates

• Men with clinically localised prostate cancer (cancer confined to the prostate)
• Patients with intermediate to high-risk prostate cancer requiring definitive treatment
• Those with life expectancy of 10 years or more who can benefit from curative treatment
• Men in good general health who can tolerate general anaesthesia
• Patients seeking nerve-sparing surgery to preserve sexual function when oncologically safe
• Those preferring a minimally invasive approach with potentially faster recovery
• Men with prostate sizes that allow for safe robotic access and manipulation

Contraindications

• Extensive previous abdominal or pelvic surgery creating significant adhesions
• Severe cardiac or pulmonary conditions preventing safe general anaesthesia
• Uncorrected bleeding disorders or inability to stop blood-thinning medications
• Active urinary tract infections requiring treatment before surgery
• Morbid obesity that may limit robotic instrument access
• Previous pelvic radiation that increases surgical complexity
• Evidence of metastatic disease requiring systemic rather than local treatment

The decision for robotic prostatectomy requires careful evaluation by an experienced urologist. Factors including cancer stage, grade, PSA levels, and individual patient characteristics all influence whether this approach offers the appropriate treatment path.

Transperitoneal Robotic Prostatectomy

The transperitoneal approach is the most commonly performed technique for robotic prostatectomy. This method involves accessing the prostate through the peritoneal cavity (the space containing abdominal organs). The surgeon creates a working space by insufflating the abdomen with carbon dioxide gas, then carefully dissects down to reach the prostate. This approach provides good visualisation of pelvic anatomy and allows for concurrent lymph node dissection when indicated.

Extraperitoneal Robotic Prostatectomy

The extraperitoneal technique, also known as the Retzius-sparing approach, avoids entering the peritoneal cavity. The surgeon accesses the prostate through the space between the bladder and pubic bone. This method may reduce the risk of post-operative hernias and bowel complications. Some surgeons prefer this approach for preserving the anterior support structures of the bladder, potentially improving early continence recovery.

Technology & Equipment Used

The robotic surgical system consists of three main components: the surgeon console where the urologist sits and controls the instruments, the patient-side cart with four robotic arms, and the vision system providing high-definition 3D visualisation. The instruments include specialised graspers, scissors, needle drivers, and energy devices for tissue sealing. Features include tremor filtration, motion scaling, and wristed instruments that bend and rotate beyond human capability.

Pre-Treatment Preparation

Before robotic prostatectomy, patients undergo comprehensive evaluation including updated PSA testing, imaging studies, and cardiac clearance if needed. Bowel preparation may be required the day before surgery. Patients must fast from midnight and arrange transportation home after discharge. Blood-thinning medications are typically stopped 5-7 days prior, under medical supervision. Pre-operative teaching includes pelvic floor exercises to aid post-operative continence recovery.

During the Procedure

The procedure begins with general anaesthesia administration and patient positioning in a head-down position to improve pelvic visualisation. The surgeon makes 5-6 small incisions (8-12mm) in the lower abdomen for robotic port placement. After insufflating the abdomen with CO2 gas, the robotic instruments are docked.

The surgeon then performs systematic dissection, first mobilising the bladder, then carefully separating the prostate from surrounding structures. When oncologically appropriate, nerve-sparing techniques preserve the neurovascular bundles controlling erection. The prostate and seminal vesicles are removed intact through one of the port sites. The bladder neck is then reconstructed and connected to the urethra over a temporary catheter. The procedure typically takes 2-4 hours depending on complexity.

Immediate Post-Treatment

Following surgery, patients recover in the post-anaesthesia care unit before transfer to the ward. Pain is generally well-controlled with oral medications. Most patients can drink clear fluids within hours and progress to regular diet by the next day. Early mobilisation is encouraged, with patients typically walking the evening of surgery. The urinary catheter remains in place, and patients receive instructions on catheter care. Hospital discharge usually occurs within 1-2 days when patients are comfortable, mobile, and tolerating diet.

First 24-48 Hours

Initial recovery focuses on pain management and preventing complications. Patients may experience shoulder discomfort from residual CO2 gas, which resolves with walking and time. The surgical sites require minimal care, typically just keeping them clean and dry. Activity is limited to light walking and basic daily activities. Patients should monitor for signs of infection including fever, increasing pain, or unusual drainage. Adequate hydration helps maintain catheter function and prevent blood clots.

First Week

During the first week, patients gradually increase walking distance whilst avoiding heavy lifting or straining. The urinary catheter requires twice-daily cleaning and monitoring of urine output. Most men can shower normally after 48 hours. Pain typically diminishes significantly, with many patients requiring only occasional pain medication by week’s end. Bowel function usually returns to normal within 3-4 days. Patients maintain pelvic floor exercises learned pre-operatively to prepare for catheter removal.

Long-term Recovery

The urinary catheter is typically removed 7-10 days post-surgery after a cystogram confirms proper healing. Initial incontinence is common, with most men requiring pads temporarily. Continence recovery varies but typically improves significantly over 3-6 months with consistent pelvic floor exercises. Return to normal activities including driving occurs around 2-3 weeks, whilst vigorous exercise and heavy lifting wait 6 weeks. Sexual function recovery, when nerves are preserved, may take 12-24 months and might benefit from rehabilitation protocols.

Robotic prostatectomy offers several evidence-based advantages for treating localised prostate cancer. The minimally invasive approach typically results in less blood loss compared to open surgery, reducing transfusion requirements. The magnified 3D visualisation and precise instrumentation may improve nerve preservation rates when oncologically feasible, potentially benefiting post-operative sexual function.

Patients generally experience less post-operative pain and faster return to normal activities compared to traditional open surgery. The smaller incisions reduce infection risk and result in minimal scarring. Hospital stays are typically shorter, with most patients discharged within 1-2 days. The enhanced visualisation may also improve cancer control through better appreciation of tissue planes and margins. Many patients report high satisfaction with the cosmetic results and overall recovery experience compared to their expectations of major surgery.

Common Side Effects

Temporary urinary incontinence affects most men immediately after catheter removal, typically improving over several months. Erectile dysfunction occurs to varying degrees, depending on pre-operative function, age, and nerve-sparing feasibility. The recovery of sexual function may take up to two years. Catheter-related discomfort and bladder spasms are common whilst the catheter remains in place. Small amounts of blood in urine are normal initially and during healing.

Rare Complications

Serious complications are uncommon but may include significant bleeding requiring transfusion (less than 2%), injury to surrounding organs like the rectum or ureters, and wound infections. Deep vein thrombosis or pulmonary embolism can occur despite preventive measures. Urinary leak at the bladder-urethra connection may prolong catheter duration. Long-term complications might include bladder neck contracture requiring dilation or urethral stricture. Very rarely, conversion to open surgery may be necessary due to technical difficulties or complications.

Our experienced surgical team employs established protocols and meticulous technique to minimise these risks. Pre-operative optimisation and careful patient selection enhance safety outcomes.

The cost of robotic prostatectomy in Singapore varies based on several factors including hospital choice, surgeon fees, and case complexity. The total fee typically encompasses pre-operative assessments, surgical costs, robotic system usage, anaesthesia services, hospital stay, and initial post-operative care. Pathology examination of the removed prostate and lymph nodes is included.

Patients should consider that whilst robotic surgery may have higher upfront costs than traditional approaches, the potentially shorter hospital stay and faster recovery may offset some expenses through reduced time away from work. Quality outcomes from experienced surgeons at established centres provide value through potentially better functional results and comprehensive cancer care. For patients also exploring options for enlarged prostate treatment in Singapore, a detailed cost estimate is provided during consultation based on individual circumstances.