Senior Director & Unit Head, Urology, Kidney Transplant, Uro-Oncology, Robotic Surgery, Max Hospital, Gurugram
Part 9 of 11 in Prostate Cancer: Diagnosis and Management
Robotic, Laparoscopic and Open Radical Prostatectomy: Comparing the Evidence
September 6, 2026
Radical prostatectomy is one of the surgeries urologists have historically dreaded, largely because of the bleeding risk from the dorsal venous complex during the open approach. Dr. Amit Goel, who trained on the da Vinci Si robotic system at a cancer centre and now operates on the newer da Vinci Xi, walked his audience through the comparative evidence for open, laparoscopic and robotic technique.
What the Trials Show
A study published in The Lancet compared robotic against open radical prostatectomy and found urinary and sexual function outcomes were similar between the two, but open surgery patients had more biochemical recurrence, a difference Dr. Goel attributed to the more precise, magnified vision available on the robotic platform. A separate systematic review and meta-analysis, published in 2018, went further, finding robotic surgery superior to laparoscopic technique on operative time, blood loss, transfusion rate, positive surgical margins, nerve sparing and recovery of both continence and erectile function, and superior to open surgery on all of the same measures.
Trifecta and Pentafecta Outcomes
Surgeons compare these techniques using a trifecta, urinary continence, erectile function and freedom from biochemical recurrence, and increasingly a pentafecta that adds clear surgical margins and freedom from major complications such as bleeding, vessel injury or bowel and rectal injury. On these measures, robotic and laparoscopic approaches both control dorsal venous complex bleeding better than open surgery, because the pressure created by pneumoperitoneum reduces blood loss, transfusion needs and, with the smaller incisions of minimally invasive surgery, hospital stay.
Cost of Robotic Surgery
When an attending doctor asked about cost during the session, Dr. Goel gave a figure of approximately 8,700 US dollars for the total cost of robotic radical prostatectomy in India, a number he offered directly, alongside his own WhatsApp contact for doctors who wanted to discuss a specific patient.
This article is based on a Jivo Masterclass session conducted by Dr. Amit Goel, Director and Head of Unit, Renal Transplant, Uro-oncology, Urology and Robotic Surgery, Max Hospital, Gurugram, India. The article has been summarised with the assistance of an AI tool from the original masterclass recording. Watch the full Masterclass recording
This guide is based on a live Jivo Masterclass: Dr. Amit Goel taught doctors across Africa on April 20, 2025.
FROM THE LIVE Q&A
Dr. Yanik
What are the survival chances after surgical treatment for a patient with prostate adenocarcinoma, and is there a possibility of recurrence?
Dr. Amit Goel
Surgery is offered specifically in patients where the goal is cure. But every patient needs lifelong follow-up, with PSA testing every three to six months, because recurrence can and does happen. Nobody can promise a patient that surgery guarantees no recurrence. That possibility is exactly what the word cancer is telling us.
Frequently Asked Questions
What is the average cost of robotic surgery for prostate cancer?▼
Approximately 8,700 US dollars, which is the total cost of the robotic surgery.
What is the management of metastatic prostate cancer?▼
It depends on where the metastasis is. Bilateral orchidectomy is still a valid option for patients who don't want to spend money on ongoing hormone injections, and it works about as well as hormone therapy. For bone metastasis with pain or fracture risk, bone-strengthening injections and radiotherapy to the affected bone are added. Once the disease becomes castration-resistant, treatment moves to stronger anti-androgens such as abiraterone or enzalutamide, chemotherapy for visceral metastasis, and increasingly immunotherapy.
What are the survival chances after surgical treatment for a patient with prostate adenocarcinoma, and is there a possibility of recurrence?▼
Surgery is offered specifically in patients where the goal is cure. But every patient needs lifelong follow-up, with PSA testing every three to six months, because recurrence can and does happen. Nobody can promise a patient that surgery guarantees no recurrence. That possibility is exactly what the word cancer is telling us.
Is robotic prostatectomy better than open surgery?▼
Trial evidence shows robotic surgery matches open surgery on urinary and sexual function while producing fewer biochemical recurrences, linked to the more precise, magnified vision the robotic platform provides.
What does 'trifecta' mean in prostate cancer surgery?▼
Trifecta refers to the three outcomes surgeons use to judge a radical prostatectomy: urinary continence, erectile function and freedom from biochemical recurrence.
In This Series: Prostate Cancer: Diagnosis and Management
- 1.Diagnosis and Management of Prostate Cancer
- 2.Prostate Cancer Risk Factors and Why Men of African Descent Face the Highest Risk
- 3.Recognizing Prostate Cancer: From Early Symptoms to Advanced and Metastatic Disease
- 4.How Prostate Cancer Is Diagnosed: PSA Testing and Digital Rectal Examination
- 5.Prostate Biopsy: TRUS-Guided and MRI Fusion Techniques
- 6.The Gleason Score: Grading Prostate Cancer and What It Means for Treatment
- 7.Staging Prostate Cancer: TNM Classification and PSMA PET Scans
- 8.Choosing a Treatment: Risk-Based Options From Active Surveillance to Surgery
- 9.Robotic, Laparoscopic and Open Radical Prostatectomy: Comparing the Evidence
- 10.The Retzius-Sparing Technique: Protecting Continence and Erectile Function After Surgery
- 11.Managing Metastatic and Castration-Resistant Prostate Cancer