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Robotic-Assisted Surgery (da Vinci)

The goal of radical prostatectomy is to: 1) excise the cancer completely; 2) provide good urinary continence post-operatively; and 3) maintain ability to have erections after the surgery (if present before the surgery). Once these goals can be met reliably, then efforts can be made to minimize post-operative discomfort.

At the University of Michigan, we are offering the newest surgical approach to prostate cancer, the laparoscopic prostatectomy. Performed with the assistance of a surgical robot (da Vinci system, Intuitive Surgical, Mountain View, CA), this procedure duplicates the standard open surgical radical retropubic prostatectomy but with smaller incisions.

Instead of the midline incision extending up from the pubic bone towards the umbilicus (as for the open surgical procedure), 5 small incisions (one-quarter to one-half inch each) are made in the lower abdomen. Through these incisions are passed the robot-controlled videocamera, 2 robotic manipulating arms, and 2 assisting instruments. The surgeon sits at a console (Figure #1) and manipulates the robot arms and directs the camera with hand-controls, while looking at the operative field with an immersive 3-dimensional view (Figure #2). The ends of the robotic arms are like miniature wrists that allow very fine movements (Figure #3).


The advantages of laparoscopic radical prostatectomies are due to the lack of large surgical incision and the excellent magnified vision. These advantages include improved cosmetic result, less blood loss, and briefer and less intense post-operative convalescence. While some surgeons claim that the laparoscopic prostatectomy (with or without robot assistance) provides better preservation of urinary continence and erectile function, we do not feel that this is the case. At this point, we feel that the laparoscopic procedure provides cancer control and urinary continence that is equivalent to that associated with the standard open surgical prostatectomy. Although it appears that the nerves for erection are being preserved, we do not feel that there is enough experience with this technique to make claims of improved erectile function.

Two videos (links below) demonstrate the robot arms performing surgery. These arms are directly controlled by the surgeon at a remote console. "automated" maneuvers are not possible with the robot. In video #1, the prostate is seen with a yellow catheter protruding through the middle of the prostate and entering the bladder. The suture is being placed in the dorsal vein complex that drains a large amount of blood from the pelvis. Control of this vein is critical. With the robot, we are able to place to suture in the exact position needed to control bleeding. In video #2, the neurovascular bundle on the right that controls the ability for a man to have erections is being separated from the prostate. The nerve bundle is in the bright yellow tissue at the bottom right of the video and the prostate is the whitish round organ in the middle. With the robot arms we are able to gently separate the nerves from the prostate.

  1. Dorsal venous complex stitch placed. Foley catheter seen between prostate and bladder.
  2. Right Lateral Prostate Fascia

We performed a comparison between open and robotic prostatectomy. All data below is from the time of surgery. Patients undergoing a Robotic prostatectomy had less blood loss and less narcotic use in the hospital.

Health Outcome Measure DVP(median)
(Robotic)		 RRP(median)
(Open)		 P value
EBL (estimated blood loss) 100CC 900cc <0.001
Operative time 207 minutes 161 min <0.001
Hospital Narcotic Use 32 mg 48 mg 0.001
LOS (length of hospital stay) 1 day 1 day Ns
Time of narcotic use 9 days 9 days Ns
Time to Normal Activity 9 days 8 days Ns
Time to driving 13 days 14 days Ns
Time to 100% Activity 21 days 28 days Ns

Service Name Appointment
Urologic Oncology/Cancer - Cancer Center 734-647-8903 
Urology - Adult - Laparoscopic - Brighton Health Center 734-936-7030