Single-port robotic prostatectomy

Robotic removal of the whole prostate and seminal vesicles for prostate cancer, done through one small cut of about 3 centimeters (just over an inch) instead of several keyholes, using the da Vinci SP single-port robot.

Also called SP prostatectomy, SP-RARP, Single-port RARP, da Vinci SP prostatectomy, Single-incision robotic prostatectomy, Extraperitoneal single-port prostatectomy, Transvesical prostatectomy, Transvesical single-port prostatectomy

Where: Hospital operating room
Anesthesia: General anesthesia (fully asleep)
Time in the room: About 2 to 4 hours
Hospital stay: Same day or one night in many centers
Going home with: Urinary catheter for about 5 to 10 days; a drain is often not needed
Back to normal: About 3 to 6 weeks
Back to work: Desk work in about 1 to 3 weeks; heavy physical work in about 6 weeks

See the steps

BladderProstateTumorSphincter muscleErection nerves

Where it happens. The highlighted part is what this procedure treats.

Overview

This is the same cancer operation as a standard robotic radical prostatectomy. The whole prostate and the seminal vesicles, two small glands attached to its back, are removed, often with nearby lymph nodes, and the bladder is sewn down to the urethra, the tube that carries urine out through the penis. What changes is the doorway. Instead of about six keyhole cuts across the belly, everything goes in and out through one small cut, usually just below the belly button.

The da Vinci SP (single port) system, made by Intuitive, was cleared by the U.S. Food and Drug Administration for urologic surgery in 2018. Its one arm passes a single tube about 1 inch (2.5 centimeters) wide into the body. Out of that tube come a 3D camera and three thin instruments with elbows and wrists that spread apart inside, like fingers opening from a closed hand. Your surgeon sits at a console in the same room and controls every movement. The robot never moves on its own.

Because everything enters at one spot, surgeons can choose routes that are harder with the standard robot. Many stay in the space in front of the bladder, outside the peritoneum, the thin lining that wraps the bowel. This is called the extraperitoneal route. Others go through the bladder itself (transvesical) or through the belly as in standard surgery (transperitoneal). Staying outside the belly lining means the bowel is not touched, which may allow less head-down tilt, less gas pain, earlier eating, and an easier operation for men with scar tissue from earlier belly surgery.

Be clear about the evidence. Studies so far come mostly from experienced centers comparing their own patients. They suggest cancer control, urinary control and erection recovery similar to standard multiport robotic surgery, with less pain medicine and more men going home the same day. Few randomized trials have compared the two, and long-term results are still being collected. Fewer surgeons have this robot, and your surgeon's experience matters more than the model of robot.

The parts of your body involved

The prostate is a walnut-sized gland that sits just below the bladder and in front of the rectum, deep behind the pubic bone. The urethra runs straight through its middle, so removing the prostate means cutting the urethra above and below it and joining the bladder to the lower urethra. Just below the prostate is the urinary sphincter, the ring of muscle that keeps you dry. Thin bundles of nerves for erections run along its sides. In front of the bladder is a space filled with fat and veins, and above and behind it the bowel sits inside the peritoneum, the lining of the belly.

Prostate
A gland about the size of a walnut that adds fluid to semen. Most prostate cancers start in its back and outer part.
Seminal vesicles
Two small glands attached to the back of the prostate that make much of the fluid in semen. They are removed with the prostate.
Bladder neck
The funnel-shaped bottom of the bladder where it meets the prostate. After the prostate is removed, it is sewn to the urethra.
Urethra and urinary sphincter
The urethra carries urine out through the penis. The sphincter is a ring of muscle around it, just below the prostate. Protecting it is the key to urinary control.
Erection nerves
Thin sheets of nerves and small vessels, called neurovascular bundles, along both sides of the prostate. They are needed for natural erections.
Peritoneum
The thin lining that wraps the bowel and other belly organs. The extraperitoneal route stays outside it, in the space in front of the bladder.

Why it’s done

The reasons to remove the prostate are the same as for any radical prostatectomy. The single-port approach is a way of doing that operation, chosen when your surgeon has the robot and the experience, and when your body and your cancer suit it.

To cure cancer inside the prostate
For intermediate-risk and many high-risk cancers that have not spread, removing the whole prostate offers a long-term cure for most men.
One small cut
Instead of about six keyholes, there is one cut of about 3 centimeters, often hidden at or just below the belly button. Some surgeons add one small extra opening for an assistant.
A shorter stay and less pain medicine
Many centers send most men home the same day or the next morning. Several reports describe less need for opioid pain pills, especially with the extraperitoneal route.
Earlier belly surgery
Scar tissue from earlier operations, such as bowel surgery or hernia repairs inside the belly, can make standard surgery slower. Routes that stay outside the belly lining or go through the bladder can avoid most of that scar tissue.
Less head-down tilt
The extraperitoneal route usually needs a gentler head-down position and lower gas pressure than standard robotic surgery. This can help some men with lung, heart or eye conditions. Your anesthesia team will advise you.
A complete report and simple follow-up
The whole prostate goes to the pathologist for an exact grade and stage, and your PSA blood test should fall to undetectable, which makes follow-up simple.

Other options

Standard (multiport) robotic prostatectomy
The same operation through about six small keyholes. It is the most common way prostatectomy is done in the U.S., widely available, and has the longest track record.
Retzius-sparing robotic prostatectomy
A multiport approach that reaches the prostate from behind the bladder and leaves the front structures in place, which may help urinary control return sooner.
Open radical prostatectomy
The same operation through one longer cut in the lower belly. Cancer control and long-term function are similar in experienced hands, with more blood loss and a slower early recovery.
Active surveillance
For low-risk and some favorable intermediate-risk cancers, regular PSA tests, MRI scans and repeat biopsies watch the cancer, with treatment only if it changes.
External beam radiation
Radiation aimed at the prostate from outside the body over about 1 to 9 weeks, often with hormone therapy for higher-risk cancers. Cure rates for many cancers are similar to surgery, with a different pattern of side effects.
Focal or whole-gland ablation
Destroying cancer with focused ultrasound, heat inside an MRI, or freezing, for carefully selected men. Side effects are usually fewer, but long-term cancer control is less certain.

In the operating room, step by step

Press play or pick a step. Each drawing shows what your surgeon is doing at that moment. Your team may do some steps differently.

YouOperating tableAnesthesia team

1 / 14

1. Going to sleep and a gentler tilt

In the operating room, the anesthesiologist puts you fully to sleep and places a breathing tube. A soft catheter is placed into your bladder after you are asleep. Your arms are tucked and padded, and the table is tilted so your head is lower than your feet.

More detail

With the extraperitoneal route, the bowel stays inside its lining and out of the way, so many surgeons use a much gentler tilt than the steep position used for standard robotic prostatectomy. For the transperitoneal route, the tilt is closer to standard. The team pads every pressure point and protects your eyes either way.

In the operating room, the anesthesiologist puts you fully to sleep and places a breathing tube. A soft catheter is placed into your bladder after you are asleep. Your arms are tucked and padded, and the table is tilted so your head is lower than your feet.
More detail
With the extraperitoneal route, the bowel stays inside its lining and out of the way, so many surgeons use a much gentler tilt than the steep position used for standard robotic prostatectomy. For the transperitoneal route, the tilt is closer to standard. The team pads every pressure point and protects your eyes either way.
Your surgeon makes one cut of about 3 centimeters (just over an inch), usually just below the belly button. For the extraperitoneal route, the surgeon opens the layer under the belly muscles and gently creates a space in front of the bladder, staying outside the belly lining. A port with a soft sealing cap goes into the opening, and carbon dioxide gas fills the space to give room to see and work. Surgeons call this gas-filled space a pneumoperitoneum. It is kept at a gentle pressure, usually 12 to 15 mmHg, and it is what gives the camera and instruments room to move.
More detail
For the transvesical route, the cut is just above the pubic bone and the port is placed directly into the bladder. Some surgeons add one small extra opening of about 1/4 to 1/2 inch at the side for an assistant to pass stitches and suction. Because the gas stays in a smaller space outside the belly lining with the extraperitoneal route, many men have less shoulder-tip pain afterward.
The robotic cart is rolled to the table and its single arm is attached to the port. Through it pass a 3D camera and three instruments about 1/4 inch (6 millimeters) wide. Inside your body they bend at an elbow and a wrist, spreading apart so they can work together. Your surgeon sits at the console in the same room, and a bedside assistant and nurse stay beside you the whole time.
More detail
At the console, your surgeon sees a magnified 3D view and moves the instruments with hand controls. Every movement comes from your surgeon's hands; the robot does not move on its own. The camera can also bend to look around corners. Because all the instruments come from one direction, the surgeon works in a narrower field, which is why this robot has its own learning curve even for experienced robotic surgeons.
With the extraperitoneal route, your surgeon is already in the space in front of the bladder, called the space of Retzius, without ever entering the belly. The bladder is eased back, and the fat on the front of the prostate is cleared so its surface can be seen.
More detail
With the transvesical route, the surgeon works from inside the bladder, starting at the bladder neck, and leaves the space in front of the bladder untouched, similar to a Retzius-sparing approach. With the transperitoneal route, the bladder is released from the front belly wall as in standard robotic surgery. Each route has trade-offs: for example, removing a full set of lymph nodes is harder through the bladder route.
Your surgeon finds the line where the bladder meets the prostate and divides it there. The catheter helps show the opening. The goal is to keep the bladder opening small and well away from the two openings where the kidney tubes (ureters) drain in.
More detail
This junction is called the bladder neck. A large middle lobe of the prostate, or an earlier TURP, makes this part more demanding. Keeping as much bladder neck as is safe may help early urinary control.
Just behind the bladder neck lie the two vas deferens tubes, which carry sperm, and the seminal vesicles. Your surgeon clips and divides the vas tubes and frees the seminal vesicles so they come out with the prostate.
More detail
The tips of the seminal vesicles lie close to the erection nerves, so many surgeons use little or no heat here and control small vessels with tiny clips.
Your surgeon lifts the prostate and opens the thin layer between its back and the rectum. This keeps the rectum safely out of the way for the rest of the operation.
More detail
This layer is called Denonvilliers fascia. Where cancer is close to the back of the prostate, the surgeon may take more of it to get a safer margin. Rectal injury is rare and, when it happens, is usually repaired right away.
The prostate's blood vessels enter along its sides. Your surgeon closes them with small clips and cuts between them. When the cancer allows, the thin sheets carrying the erection nerves are peeled off the prostate and left in your body. This can be done on both sides, one side, or neither.
More detail
Near the nerves, surgeons avoid heat as much as possible, because heat and stretching can stun the nerves for months. Cancer control comes first, so your surgeon may decide during the operation to take more tissue on one side.
A cluster of veins runs across the top of the prostate near its tip. Your surgeon seals it with a stitch. Then, at the lowest tip of the prostate, called the apex, the urethra is cut across slowly and carefully, because the urinary sphincter sits just below. With this cut, the prostate is completely free.
More detail
The vein cluster is called the dorsal venous complex. Surgeons try to keep as much urethral length and sphincter muscle as is safe, because this helps urinary control, while still leaving a clear margin around the cancer.
The prostate is placed in a small plastic bag and set aside. If your cancer has a meaningful chance of spreading, your surgeon also removes the lymph nodes along the large blood vessels on both sides of the pelvis.
More detail
When lymph nodes are removed through the extraperitoneal route, lymph fluid has less room to be absorbed, so some surgeons make a small window into the belly lining to let it drain away. This may lower the chance of a fluid pocket called a lymphocele. The obturator nerve, which moves the thigh inward, and the iliac vessels are kept intact.
Many surgeons first place a support stitch behind the area where the bladder and urethra will meet. Then the bladder neck is sewn to the urethra with one continuous stitch that runs all the way around. A fresh catheter is passed into the bladder before the last part of the stitch is pulled snug.
More detail
The new join is called the anastomosis. Sewing through one port is slower to learn, because the needle driver and grasper come from the same direction, but the finished join is the same as in standard robotic surgery.
Your surgeon fills the bladder with sterile salt water through the catheter to make sure the new join does not leak. The gas pressure is lowered to check for bleeding. With the extraperitoneal route, many surgeons do not leave a drain.
More detail
If a small leak shows, an extra stitch usually seals it. Because the urine and any fluid stay outside the belly lining, a small leak is less likely to irritate the bowel, which is one reason drains are often skipped.
The robot is undocked and the gas is let out. Because the opening is already about 3 centimeters, the bag holding the prostate usually comes out through it, sometimes after widening it slightly for a large prostate. The deep layer is closed with strong stitches, and the skin with dissolving stitches and skin glue. Surgeons call this gas-filled space a pneumoperitoneum. It is kept at a gentle pressure, usually 12 to 15 mmHg, and it is what gives the camera and instruments room to move.
More detail
The prostate goes to the pathology lab, and the full report usually takes about 1 to 2 weeks. The single opening is the most likely place for a hernia to form later, so it is closed with care. Whether hernias are more or less common than after multiport surgery is still being studied.
You wake up in the recovery room with the catheter in place. It drains urine and holds the new join steady while it heals, usually for about 5 to 10 days. A small water balloon on its tip, inside your bladder, keeps it from slipping out.
More detail
Do not pull on the catheter or let anyone remove or replace it outside your surgeon's plan. If it falls out early, call your surgeon right away, because putting a new one in blindly can damage the fresh join.

Your surgeon is in control the whole time

The surgeon sits at a console a few steps from you and moves every instrument with hand controls and foot pedals. The robot cannot move on its own or make decisions.

A magnified 3D view

A camera on one arm gives the surgeon a bright, three-dimensional picture magnified about ten times, which helps them see small nerves and vessels.

Wristed instruments through keyholes

The instruments are about the width of a pencil and bend like a wrist inside your body, so the surgeon can stitch and dissect through small openings.

A team at your side

A bedside assistant and a scrub nurse stay at the table, and the anesthesia team watches your breathing and blood pressure throughout. Most U.S. hospitals use the da Vinci system made by Intuitive.

After the operation

Right afterward

The recovery room
You are watched for 1 to 2 hours as you wake. A sore throat from the breathing tube is common. Facial puffiness is usually less than after steep-tilt surgery.
Walking within hours
Nurses help you sit up and walk within a few hours. Walking eases gas pain, wakes up the bowels, and lowers the risk of blood clots.
Eating and drinking
You can usually drink right away and eat light food the same day, especially when the bowel was not touched.
Pain control
Most men do well with scheduled acetaminophen, sometimes with an anti-inflammatory medicine or a numbing injection at the incision, and few or no opioid pills.
Learning catheter care
A nurse shows you how to switch between a small leg bag for the day and a larger bag for the night, and how to empty them and keep the tip of the penis clean.
Going home
Men who are walking, drinking, comfortable on pills and confident with the catheter often go home the same evening or the next morning. If anything is not right, you stay.

At home

Pain
Expect soreness at the single incision, most when you sit up or cough, for about 1 to 2 weeks. Hold a pillow against it when you cough. Shoulder-tip gas pain, if any, usually lasts only a day or two.
Wound and showering
You can usually shower after 24 to 48 hours. Let soapy water run over the incision and pat it dry. Skin glue peels off on its own in 1 to 2 weeks. Avoid baths, hot tubs and swimming until the wound is healed and the catheter is out.
Catheter care
Keep the bag below the level of your bladder. Wash the tip of the penis daily and put a little lubricant where the tube enters. Strap the tube to your thigh so it does not tug. Pink urine or small clots are common.
Bladder spasms
Sudden cramping behind the pubic bone or at the tip of the penis, with urine leaking around the catheter, is a bladder spasm. It is common and harmless. Ask about a spasm medicine if they are frequent.
Diet and bowels
Eat normal food as your appetite returns and drink enough to keep urine light yellow. Take a stool softener while on any opioid and avoid straining. Do not use enemas or suppositories unless your surgeon says so.
Activity and lifting
Walk several times a day. Avoid lifting more than about 10 to 15 pounds (4.5 to 7 kilograms), hard exercise, and bicycle riding for about 6 weeks, to protect the incision and the new join.
Driving
Most surgeons ask you not to drive while the catheter is in or while you take opioid pain pills.
Work
Desk work is often possible in about 1 to 3 weeks, sometimes sooner from home. Heavy work usually needs about 6 weeks.
Sex and erections
Sexual activity can resume when you feel ready after the catheter is out. Your team may start you on an erection pill or a vacuum device as part of a recovery plan.

Recovery timeline

Day 0
Surgery day
Surgery takes about 2 to 4 hours. You wake with a catheter and one small dressing and walk within hours. Many men go home that evening.
Day 1
Home
If you stayed overnight, you usually go home the next morning with the catheter and a leg bag.
Days 2 to 7
The catheter week
Incision soreness fades. Energy is low and naps help. Bowels settle back to normal.
Days 5 to 10
Catheter out
A nurse removes the catheter in clinic in a few seconds. Leakage is expected at first, so bring pads. Daily Kegel exercises begin.
Weeks 1 to 2
Pathology results
Your surgeon reviews the full lab report: grade, margins, seminal vesicles and lymph nodes.
Weeks 3 to 6
Back to most activities
Most men are back to daily routines and desk work, with heavier lifting and cycling after about 6 weeks.
Weeks 6 to 12
First PSA test
Your first PSA after surgery should be undetectable.
3 to 6 months
Leakage improving
Many men are dry or need only a light pad. Erection recovery is slower and often just beginning.
1 to 2 years
Long-term recovery
Most men reach their final level of urinary control by about 1 year, and erections can keep improving for 2 years or more. PSA checks continue.

What it feels like

Men who have this operation often say the first days were easier than they expected, with one sore spot instead of several. The weeks after are much like any prostatectomy: a catheter, some leaking, and waiting for results.

The night before
Many men feel a mix of dread and relief that the waiting is nearly over. Some also wonder whether choosing a newer robot was the right call.
What helpsWrite down your last questions, including how many single-port operations your surgeon has done. Set out pads, loose clothes and your recovery chair ahead of time.
Waking up
Grogginess, a scratchy throat, and a constant urge to pee from the catheter even though the bladder is empty. The incision near the belly button feels tight.
What helpsTell the nurse early about nausea or pain. The catheter urge usually fades within a day as you get used to it.
Going home the same day
Leaving the hospital a few hours after a cancer operation can feel too fast, and some men and partners feel nervous the first night. Others are simply glad to be in their own bed.
What helpsMake sure you know who to call at night and have the number saved. Have your partner or friend watch the catheter teaching too. Most worries the first night are about the catheter, and a quick phone call usually settles them.
The single incision
The one cut is the sore spot, most when you sit up, cough or laugh. Some men feel a firm ridge under it as it heals.
What helpsRoll to your side before sitting up and hold a pillow over the incision when you cough. The firm ridge softens over a few months.
The catheter week
The tip of the penis gets sore, the tube tugs when you move, and urine or blood may leak around it, especially with a bowel movement. Bladder spasms can come in waves.
What helpsStrap the tube to your thigh with some slack and use lubricant at the tip. Check that the tubing is not kinked. Ask about a spasm medicine if needed.
The day the catheter comes out
Relief, then often frustration. Most men leak when they stand, cough or lift, and more later in the day as the muscles tire.
What helpsBring pads and spare clothes to that visit. Do your Kegel exercises, cut back on caffeine and alcohol, and track pads week by week rather than day by day.
Erections and intimacy
Erections are usually weak or absent at first, even with nerve sparing. Orgasm still happens but is dry. Many men grieve this quietly.
What helpsAsk for a penile recovery plan, which may include pills, a vacuum device or injections. Talk openly with your partner; closeness does not depend on erections alone.
Waiting for the PSA
The days before each PSA test can bring back the fear you felt at diagnosis.
What helpsKnow the date of the test and when you will hear. Ask ahead of time how an undetectable result appears on your report.

How well it works

Success is measured the same way as for any prostatectomy: the cancer is removed with clear edges, the PSA becomes undetectable, and over the next year you regain urinary control and as much sexual function as possible.

The pathology report
The lab reports the grade group, the stage, the margins (whether cancer touched the cut edge), and the lymph nodes. Reports from expert centers show margin rates similar to multiport surgery.
PSA after surgery
The PSA should become undetectable within about 6 to 12 weeks. A PSA that later rises to 0.2 ng/mL or higher, confirmed on a second test, is the usual definition of cancer coming back.
Urinary control
Most men improve steadily over 3 to 12 months, and most use no pad or one light pad by a year. Some reports suggest the transvesical route may bring early control back sooner, but this needs more study.
Sexual function
Erection recovery takes 1 to 2 years and depends mostly on your age, your erections before surgery, and how much nerve tissue was kept, not on the number of ports.
How it compares
So far, single-port surgery appears to match multiport surgery for cancer control and function in experienced hands, with fewer pain pills and shorter stays in many reports. Long-term data are still being gathered.

Risks

Every operation has risks. These are the ones people ask about most, with honest odds where good numbers exist. Your surgeon’s own results matter more than averages.

Common

Urine leakageNearly everyone at first; by 1 year, about 1 in 10 men still has bothersome leakage

Leakage with coughing, standing or lifting is expected after the catheter comes out and improves over months.

Erection problemsMost men at first

Erections weaken or stop after surgery, at least for a while. Recovery depends on age, erections before surgery and nerve sparing.

No semen and no natural fertilityEveryone

Orgasm still happens, but no fluid comes out. You cannot father a child naturally. This is permanent.

Incision soreness

The single incision is sore for 1 to 2 weeks, more than any one keyhole would be.

Bladder spasms and catheter discomfort

Cramps and sudden urges while the catheter is in are common and usually stop once it is removed.

Changes with orgasm and penis length

Some men leak a little urine at climax or notice the penis looks a little shorter.

Less common

Urine leak at the new join

Urine can seep through the join while it heals. It usually seals if the catheter stays in a little longer.

Lymph fluid collection (lymphocele)

After lymph node removal, fluid can collect in the pelvis. A large one can cause pain, leg swelling or infection and may need draining.

Hernia at the incision or in the groin

A bulge can form at the single incision or in the groin in the first year or two. It can be repaired if it bothers you.

Scar narrowing at the joinAbout 1 to 2 in 100

Scar tissue can narrow the connection between bladder and urethra, causing a weak stream months later. It is usually treated with a short scope procedure.

Infection

Urine infections and wound infections are uncommon and treated with antibiotics.

Blood clotsAbout 1 in 100 or fewer

Clots in the leg veins or lungs are uncommon. Walking, leg sleeves and sometimes blood thinner shots lower the risk.

Rare

Rectal injuryFewer than 1 in 100

A small tear in the rectum is rare and is usually repaired during surgery.

Bleeding needing a transfusion

Blood loss is usually low, and a transfusion is rarely needed.

Injury to a ureter, nerve or large blood vessel

These structures lie close to the work area. Injury is rare and usually repaired right away.

Adding ports or changing approach

If the single port does not give safe access, your surgeon may add ports, switch to the multiport robot, or very rarely open surgery.

Call your care team or go to the emergency room if

Fever of 101°F (38.3°C) or higher, or shaking chills.
No urine draining into the bag for more than 1 to 2 hours, especially with lower belly pain or fullness. Check the tubing for kinks first, then call right away.
The catheter falls out or slips partway out. Call your surgeon right away and do not let anyone put in a new one without speaking to your surgeon first.
Thick blood or clots in the urine that do not clear after resting and drinking more, or that block the catheter.
Swelling, pain or warmth in one calf or thigh. Call 911 for sudden shortness of breath or chest pain.
Belly pain that keeps getting worse, a swollen belly, repeated vomiting, or no gas or bowel movement for 3 days.
Redness spreading from the incision, pus, a wound that opens, or a new bulge at the incision.
After a same-day discharge: you cannot keep fluids down, or your pain is not controlled by the pills you were given.

Questions to ask your surgeon

How many single-port prostatectomies have you done, and what are your results for leakage, erections and margins?
Which route do you plan for me (extraperitoneal, transvesical or transperitoneal), and why?
Does my prostate size, a middle lobe, my weight or my earlier surgery affect whether single port is a good choice?
Will you remove lymph nodes, and can you do that through this route?
Will you add an extra port for an assistant?
Can you spare the nerves on one or both sides?
Will I go home the same day, and what happens if I need help that night?
How long will I have the catheter?
If you would recommend multiport surgery for someone like me, why?
What is your plan for erection recovery and pelvic floor therapy?
When will I get my pathology results and my first PSA?

Words you may hear

Pneumoperitoneum: The gas-filled belly that makes keyhole surgery possible. Carbon dioxide is pumped in through a thin needle or the first port until the belly wall lifts like a tent (usually at a pressure of 12 to 15 mmHg), giving the camera and instruments room to work. The gas is let out at the end, and the little that remains is absorbed and breathed out over a day or two; it can cause shoulder-tip ache in the meantime.
da Vinci SP: A single-port surgical robot that passes a camera and three bendable instruments through one tube about 1 inch wide.
Single-port surgery: Keyhole surgery done through one small opening instead of several.
Peritoneum: The thin lining that wraps the bowel and other belly organs.
Extraperitoneal: Working outside the belly lining, in the space in front of the bladder, without touching the bowel.
Transvesical: Working through the bladder: the port is placed into the bladder and the prostate is removed from inside it.
Transperitoneal: Working through the belly lining, as in standard robotic surgery.
Space of Retzius: The space between the pubic bone and the front of the bladder and prostate, filled with fat and veins.
Seminal vesicles: Two small glands behind the prostate that make much of the fluid in semen.
Anastomosis: The new join between the bladder neck and the urethra.
Nerve sparing: Peeling the erection nerves off the prostate and leaving them in the body.
Foley catheter: A soft tube through the penis into the bladder, held in by a small water balloon.
PSA (prostate-specific antigen): A protein made by prostate tissue, measured with a blood test. After the prostate is removed, it should be undetectable.
Surgical margin: The cut edge of the removed prostate. A positive margin means cancer cells touch that edge.
Lymphocele: A pocket of lymph fluid that can collect after lymph nodes are removed.

Common questions

Is single-port surgery better than standard robotic surgery?

It has not been shown to be better for cancer control or long-term function. In experienced centers it appears similar, with one incision, fewer pain pills and more same-day discharges. The experience of your surgeon matters more than the number of ports.

Is one 3 centimeter cut really better than six small ones?

Many men find one cut easier to care for and less painful overall, and the scar is often hidden at the belly button. The single cut is larger than any one keyhole, so it is the sore spot for a week or two.

Can I really go home the same day?

Many centers now send most single-port patients home the same day or the next morning, when they are walking, drinking and comfortable. If you or your team are not comfortable, you stay overnight.

Does the robot do the operation?

No. Your surgeon does the operation from the console. The robot holds the camera and instruments and moves them only as your surgeon's hands move the controls.

Can lymph nodes be removed through one port?

Yes, with the extraperitoneal and transperitoneal routes. A full lymph node removal is harder through the bladder route, so that route is usually chosen for men who do not need extended node removal.

Will I leak less than after standard surgery?

Long-term leakage appears similar. Some reports suggest earlier control with certain routes, but this has not been proven in large trials.

What if my surgeon cannot finish through one port?

Your surgeon may add a port or switch to the multiport robot. This is uncommon, and it is done for your safety. Ask about it before surgery so it does not come as a surprise.

Sources this page draws on

American Urological Association and American Society for Radiation Oncology, Clinically Localized Prostate Cancer: AUA/ASTRO Guideline (2022)
American Urological Association and Society of Urodynamics, Female Pelvic Medicine and Urogenital Reconstruction, Incontinence after Prostate Treatment: AUA/SUFU Guideline (2019)
European Association of Urology, EAU-EANM-ESTRO-ESUR-ISUP-SIOG Guidelines on Prostate Cancer
U.S. Food and Drug Administration, 510(k) clearance of the da Vinci SP Surgical System for urologic surgical procedures (2018)
American Cancer Society, Surgery for Prostate Cancer

Written November 2026. This page explains what usually happens. It is not medical advice and does not replace a conversation with your own surgeon, whose plan for you comes first.

Single-port robotic prostatectomy

Overview

The parts of your body involved

Why it’s done

Other options

Getting ready

Weeks before

The week before

The day before

The morning of surgery

In the operating room, step by step

1. Going to sleep and a gentler tilt

After the operation

Right afterward

At home

Recovery timeline

What it feels like

The night before

Waking up

Going home the same day

The single incision

The catheter week

The day the catheter comes out

Erections and intimacy

Waiting for the PSA