Robotic Urologic Cancer Surgery

What robotic surgery is (in practical terms)

Robotic urologic surgery is still surgeon-led surgery. The “robot” does not make decisions or perform steps independently.

Instead, robotic systems allow the surgeon to:

• operate through small incisions using fine instruments,

• work with a magnified 3D view of the surgical field,

• and use instruments that can articulate with a greater range of motion than standard straight laparoscopic instruments.

For many patients, a minimally invasive approach may be associated with:

• smaller wounds,

• less early post-operative discomfort,

• and a potentially quicker return to day-to-day activities—depending on the operation and the individual.

What robotics can change — and what it cannot

What it can change

Robotic systems can be helpful where surgery requires careful dissection in tight spaces, fine suturing, or meticulous control around delicate structures. In urologic cancer surgery, that may translate to:

• improved visualisation for the surgeon,

• controlled instrument movement,

• and potentially more consistent execution of complex steps in experienced hands.

What it cannot change

Robotics does not remove the need for good judgement.

It does not replace:

• appropriate patient selection,

• accurate staging and planning,

• decisions about when not to operate,

• or the honest discussion of trade-offs (cancer control versus function).

And it does not eliminate surgical risk. The most important determinants of outcome are typically the biology of the cancer, the appropriateness of the chosen treatment pathway, and the quality of decision-making and technique across the whole team.

Where robotic surgery fits in urologic cancer care

Robotic surgery is commonly used for several cancer operations in urology. The right choice depends on the cancer, anatomy, prior surgery/radiation, general health, and patient priorities.

Prostate cancer surgery (radical prostatectomy)

For men and people with prostates who need surgery for prostate cancer, a radical prostatectomy involves removal of the prostate and seminal vesicles, and sometimes lymph node assessment depending on risk features.

Key considerations include:

• cancer control (risk group and stage),

• the feasibility and appropriateness of nerve-sparing,

• and recovery expectations, particularly urinary control and erectile function.

For the broader pathway—including active surveillance and radiation options—see the prostate cancer information page.

Kidney cancer surgery (partial or radical nephrectomy)

Many kidney cancers are found incidentally on imaging. Treatment ranges from active surveillance (in selected small renal masses) through to partial nephrectomy (kidney-sparing surgery) or radical nephrectomy (removal of the kidney) where required.

The central decision is often not “robotic versus not robotic”, but:

• whether surveillance is safe,

• whether kidney-sparing surgery is feasible and oncologically appropriate,

• and how to balance kidney function with cancer control.

For the broader kidney cancer pathway—including surveillance and partial vs radical nephrectomy—see Kidney Cancer.

Bladder cancer surgery (radical cystectomy)

For selected cases of muscle-invasive bladder cancer (or high-risk non–muscle-invasive disease), cystectomy may be recommended. This is a major operation with life-changing implications, and the decision-making is inherently multidisciplinary.

Where robotic surgery is used, it is within an overall care plan that often includes medical oncology and, in some cases, radiation oncology.

For the broader bladder cancer pathway—including TURBT, non-muscle invasive vs muscle-invasive disease, and bladder-preserving options—see the Bladder Cancer page.

Upper urinary tract cancer (nephroureterectomy)

Cancers arising in the renal pelvis or ureter (upper tract urothelial carcinoma) may require removal of the kidney and ureter (nephroureterectomy) in selected cases. The most important drivers are tumour risk features and staging, rather than the surgical platform.

How the decision is made (and why restraint matters)

Not every cancer needs immediate treatment, and not every patient benefits from surgery.

A judgement-led pathway typically starts with:

• confirming diagnosis and risk,

• staging appropriately,

• and weighing treatment options (including surveillance or non-surgical treatments where appropriate).

For prostate cancer in particular, the decision is often between:

• active surveillance,

• surgery,

• and radiation-based options.

A good decision is one you can defend clinically and live with personally—not one that is rushed or framed as “one obvious best option.”

Recovery realism

Recovery depends on the operation, baseline fitness, comorbidities, and the complexity of the surgery.

In broad terms, many minimally invasive patients can expect:

• mobilisation on the day of surgery or the following day,

• a hospital stay that varies by operation (short for some procedures, longer for others such as cystectomy),

• and a graded return to activity over weeks.

For prostatectomy, urinary catheter care and early pelvic floor rehabilitation are commonly part of recovery planning. For kidney surgery, activity restrictions and follow-up imaging depend on the operation and pathology. For cystectomy, recovery is more intensive and requires careful preparation and support.

Technology used

Where robotic surgery is appropriate, I use a robotic surgical system (commonly referred to as the da Vinci platform). The surgeon operates from a console in the operating room, controlling the camera and instruments in real time. The system is a tool that can assist with visualisation and instrument control; it does not make surgical decisions.