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Recovery Time Prostatectomy Robotic – Is Robotic Surgery Better?

Last Updated on November 27, 2025 by Bilal Hasdemir

Recovery Time Prostatectomy Robotic – Is Robotic Surgery Better?
Recovery Time Prostatectomy Robotic – Is Robotic Surgery Better? 4

Every year, over 240,000 men in the United States get diagnosed with prostate cancer. Many choose surgery as a treatment. Robotic prostate surgery, using the da Vinci Surgical System, is popular. It’s known for being less invasive and precise.

Robotic prostate surgery has many advantages, including less blood loss and fewer complications. Patients can get back to their daily lives faster with this precise method. Understanding the recovery time prostatectomy robotic is key for patients, as it helps them know what to expect during recovery and make informed decisions. Typically, hospital stays last one to two days, with catheter removal about 7 to 14 days post-surgery. Most patients can resume normal activities within 2 to 3 weeks, and full recovery often occurs in 4 to 6 weeks, depending on individual health and job type.

Key Takeaways

  • Robotic prostate surgery is a minimally invasive procedure with several benefits.
  • The da Vinci Surgical System is a leading technology in robotic prostate surgery.
  • Patients can expect a quicker recovery with robotic surgery compared to traditional methods.
  • Understanding the recovery process is essential for managing patient expectations.
  • Robotic prostate surgery reduces the risk of complications and promotes faster healing.

The Evolution of Prostate Surgery

Recovery Time Prostatectomy Robotic – Is Robotic Surgery Better?
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Prostate surgery has changed a lot, making treatments more precise and less invasive. It has moved from old open surgeries to new laparoscopic and robotic-assisted methods. These changes offer patients better options for their health.

Traditional Open Prostatectomy Methods

Old open prostatectomy needs a big cut in the belly to reach the prostate. It’s been used for years, but it has big downsides. These include longer healing times, higher infection risks, and more blood loss.

Even with these problems, it’s been a key treatment for prostate cancer.

Laparoscopic Techniques Development

Laparoscopic surgery is a big step towards less invasive care. It uses small cuts and a camera to see inside the body. This method helps patients heal faster and leaves fewer scars.

But it’s harder for surgeons to do because they have to work through tiny openings.

Introduction of Robotic-Assisted Surgery

Robotic-assisted surgery has changed prostate surgery even more. Systems like the Da Vinci Surgical System give surgeons better views and control. This makes surgeries more precise and less invasive.

Robotic prostatectomy is getting more popular because it can lead to fewer complications and better results for patients.

Surgical MethodRecovery TimeBlood LossPrecision
Open ProstatectomyLongerSignificantHigh
Laparoscopic ProstatectomyModerateLessHigh
Robotic-Assisted ProstatectomyShorterMinimalVery High

The table shows how robotic-assisted surgery beats old methods. As tech gets better, robotic surgery will likely improve even more. This means better care for those needing prostate surgery.

Understanding Robotic Prostate Surgery Technology

Recovery Time Prostatectomy Robotic – Is Robotic Surgery Better?
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Robotic prostate surgery with the Da Vinci system is a new way to treat prostate cancer. It uses advanced robots to make surgery better. This method is less invasive than old surgeries, making it safer and more precise.

The Da Vinci Surgical System Explained

The Da Vinci Surgical System is a top-notch robot for surgeons. It has a console for the surgeon, a cart with four arms, and a 3D vision system. This setup helps surgeons see better, move more precisely, and control the surgery more effectively.

How Robotic Systems Assist Surgeons

Robotic systems, like the Da Vinci, help surgeons a lot. They offer:

  • Improved dexterity: The arms can move in ways humans can’t, making surgery more precise.
  • Enhanced visualization: The 3D vision system gives a clear view of the surgery area.
  • Reduced tremors: The system removes hand tremors, making surgery smoother.

Technological Advancements in Surgical Robotics

The world of surgical robotics is always getting better. New tech is coming out to help patients more. Some recent updates include:

Technological AdvancementDescriptionBenefit
Artificial Intelligence (AI) IntegrationAI is being added to robots to analyze data and make predictions during surgery.This makes surgery more precise and informed.
Improved Robotic ArmsNew robotic arms are more flexible and can move in new ways.This lets surgeons do more complex tasks.
Enhanced Imaging SystemsNew imaging tech gives clearer views of the surgery area.This helps surgeons see important details better.

These new tech advancements in robotic surgery are changing how we treat prostate cancer. They make surgery less invasive, leading to faster recovery times and fewer problems.

How Long Does Robotic Prostate Surgery Take?

Many people wonder how long robotic prostate surgery takes. Knowing this helps patients get ready for the surgery and recovery.

Average Duration of Robotic Procedures

Robotic prostate surgery usually lasts between 2 to 4 hours. But the exact time can change. This depends on the surgery’s complexity, the surgeon’s skill, and the robotic system used.

Even though the surgery itself is not very long, you’ll spend more time in the operating room. This is because of preparation and recovery from anesthesia.

Factors Affecting Surgery Time

Several things can affect how long robotic prostate surgery takes. These include:

  • The patient’s overall health and any previous surgeries.
  • The stage and complexity of the prostate cancer.
  • The surgeon’s level of experience with robotic prostatectomy.
  • The specific model of the robotic surgical system being used.

More experienced surgeons and advanced robotic systems might make the surgery shorter. But, this isn’t always true.

Comparison with Traditional Surgery Duration

Robotic prostate surgery usually takes as long as or a bit longer than traditional open prostatectomy. Laparoscopic prostatectomy has a similar duration to robotic surgery, as both are minimally invasive.

But the recovery time for robotic prostatectomy is shorter. You’ll likely feel less pain and have fewer complications. This makes the slightly longer surgery time worth it for many patients.

The Prostatectomy Da Vinci Robotic Surgery Process

Prostatectomy Da Vinci robotic surgery is a cutting-edge procedure. It combines advanced technology with skilled surgical expertise. The process includes several stages, from preparation to post-operative care, each vital for success.

Pre-Surgical Preparation

Before robotic prostate surgery, patients go through a detailed preparation. This includes:

  • A thorough medical evaluation to check overall health and identify risks.
  • Review of medical history to adjust medications and manage conditions.
  • Detailed talks with the surgical team about the procedure, expectations, and post-operative care.
  • Pre-operative tests like blood work, imaging studies, and other diagnostic tests.

Preparation is key to a successful surgery. Patients are told to follow specific instructions from their healthcare team. This may include dietary changes, stopping certain medications, and other measures.

Step-by-Step Surgical Procedure

The Da Vinci robotic system allows surgeons to perform prostatectomy with great precision. The procedure involves:

  1. Administering anesthesia for the patient’s comfort during surgery.
  2. Making small incisions for the robotic arms.
  3. Using the Da Vinci console to control the robotic instruments for precise dissection and removal of the prostate gland.
  4. Performing lymph node dissection if necessary, based on the patient’s condition and cancer stage.
  5. Closing the incisions with sutures or staples.

Post-Operative Care Protocol

After robotic prostate surgery, patients are closely monitored in the recovery room. Post-operative care includes:

  • Pain management through medication and other strategies.
  • Monitoring for any signs of complications or adverse reactions.
  • Encouraging early mobilization to prevent blood clots and promote healing.
  • Providing instructions on wound care, follow-up appointments, and resuming normal activities.

The recovery process is supported by a team of surgeons, nurses, and other healthcare professionals. Understanding what to expect during recovery helps patients navigate this period more effectively.

Aspect of CareDescriptionBenefits
Pain ManagementUse of medication and other strategies to manage pain.Enhanced patient comfort, reduced stress.
Wound CareInstructions on caring for surgical incisions.Promotes healing, reduces the risk of infection.
Follow-UpSchedule for post-operative check-ups.Monitors recovery, addresses concerns.

By understanding the prostatectomy Da Vinci robotic surgery process, patients can better prepare themselves. This includes the initial preparation stages through to recovery and beyond.

Benefits of Robotic-Assisted Prostate Surgery

Robotic-assisted prostate surgery has changed how we treat prostate cancer. It offers many benefits over old surgical methods. The use of robotic technology in prostatectomy has improved patient results. It gives surgeons better tools for precision and control.

Enhanced Surgical Precision and Visualization

The prostatectomy robot has high-definition 3D visualization. This lets surgeons see the surgical area clearly and in detail. The robotic system’s precise tools help surgeons do complex tasks more accurately.

The robotic system also reduces hand tremors and scales down the surgeon’s movements. This makes the surgery more precise. In prostate surgery, this is key because of the delicate nerves and structures near the prostate.

Reduced Blood Loss and Transfusion Rates

Robotic prostate surgery reduces blood loss during the procedure. The robotic system’s precise dissection and cautery instruments help. This means patients usually lose less blood than with traditional surgery.

Less blood loss means fewer blood transfusions. It also makes the surgical area cleaner. This helps the surgeon see better and work more effectively.

Smaller Incisions and Cosmetic Advantages

Robotic-assisted prostate surgery uses small incisions in the abdomen. These incisions are smaller than those in traditional open prostatectomy. This results in less tissue damage and smaller scars.

The smaller scars are less noticeable. This is a big plus for many patients. It can make them happier with their surgery experience.

Potential Drawbacks of Robotic Prostatectomy

The robotic prostatectomy procedure has its challenges. It’s important for patients to know the possible drawbacks before deciding. These can affect their choice and outcome.

Cost Considerations

One big drawback is the cost. The Da Vinci Surgical System is pricey to buy and keep up. Patients often have to pay a lot, making it more expensive than other surgeries. Insurance coverage can vary, leading to big bills for some.

The cost also includes the surgeon’s fees and hospital stay. Even though robotic surgery might mean a shorter hospital stay, the total cost can be higher. This is because of the robotic system’s cost and the training needed for surgeons.

Learning Curve for Surgeons

The learning curve for surgeons is a big deal. Robotic prostatectomy needs special training and skill. Not all surgeons have this, making it a challenge.

This learning curve can affect patient results. If the surgeon isn’t experienced, outcomes might not be as good. Studies show that more experienced surgeons get better results, making it key to choose the right one.

Technical Limitations and Complications

Robotic systems are precise and offer great views, but they’re not perfect. Technical issues can happen, even if rare. These might mean switching to a different surgery type.

Patients might face problems like urinary issues, erectile dysfunction, or infections. These risks are similar to those of traditional surgeries. The surgeon’s skill and the patient’s health play a big role in these risks.

It’s vital for patients to know these possible downsides before choosing robotic prostatectomy. By understanding both the pros and cons, they can make better choices for their treatment.

Recovery Time Prostatectomy Robotic vs. Traditional Approaches

Robotic prostate surgery and traditional open surgery have different recovery times and outcomes. The Da Vinci Surgical System makes robotic surgery more precise and less invasive. This can greatly affect how quickly patients recover.

Hospital Stay Duration

Robotic prostatectomy means shorter hospital stays. Patients are often home in 1-2 days after surgery. Traditional open surgery, with bigger cuts, can keep patients in the hospital for 3-4 days or more.

Pain Management

Robotic surgery causes less pain because it’s less invasive. Smaller cuts mean less damage to tissues. This leads to less pain and a lower need for strong pain meds. Open surgery, with bigger cuts, can cause more pain and require more pain meds.

Return to Normal Activities

Robotic surgery lets patients get back to their lives faster. They can usually start their normal routines in a few weeks. Traditional surgery takes longer to recover from, often needing more time to get back to normal.

In summary, robotic prostate surgery has better recovery times than traditional surgery. It means shorter hospital stays, less pain, and a quicker return to daily activities. As technology improves, robotic surgery will likely offer even better results for patients.

Recovery Time for Robotic Prostatectomy: What to Expect

The recovery after robotic prostatectomy has different stages. Each stage has its own challenges and milestones. Knowing what to expect can make the transition back to normal life easier.

First Week After Surgery

The first week is key to a smooth recovery. Patients should rest and avoid hard activities. Pain management is done with medicine and other treatments.

Patients might feel some pain, swelling, and bruising. But these symptoms usually go away in a few days.

Weeks 2-4 Recovery Milestones

Weeks 2-4 bring big improvements. The urinary catheter is removed in the first week or two. This is a big step in recovery.

Patients start doing normal activities again. This includes light exercises and going out. But, they must follow their doctor’s advice closely.

Recovery MilestoneTypical Timeline
Removal of Urinary Catheter7-14 days post-surgery
Resuming Light Exercises2-3 weeks post-surgery
Returning to Work3-4 weeks post-surgery

Long-Term Recovery Considerations

Recovery takes time, even after the first few weeks. Patients should keep doing pelvic floor exercises to help with urinary control.

It’s important to keep up with follow-up appointments. This helps track progress and solve any problems that come up.

Managing Side Effects After Robotic Prostate Surgery

Managing side effects is key after robotic prostate surgery. This surgery is popular for being less invasive. It reduces blood loss and hospital stays. Yet, patients may face several side effects.

Urinary Incontinence Management

Urinary incontinence is a common side effect. Pelvic floor exercises, also known as Kegel exercises, can help. They strengthen muscles that control urination, reducing incontinence.

Patients are advised to start these exercises before and after surgery. Medications may also be given to manage incontinence. In some cases, further treatment is needed if incontinence doesn’t improve.

Erectile Dysfunction Considerations

Erectile dysfunction (ED) is another possible side effect. The extent of ED varies. It depends on the patient’s pre-surgical function and the surgery’s nerve-sparing techniques.

Nerve-sparing robotic prostatectomy tries to preserve nerves. This can help maintain erectile function. Post-operative rehabilitation, including medications and treatments, can also help in recovery.

Other Possible Side Effects and Their Duration

Patients may also experience fatigue, mild pain, or bowel habit changes. These side effects are usually temporary and get better over time.

Side EffectTypical DurationManagement Strategies
Urinary IncontinenceSeveral weeks to monthsPelvic floor exercises, medications
Erectile DysfunctionVariable, potentially long-termNerve-sparing surgery, medications, and rehabilitation
FatigueSeveral weeksRest, gradual increase in physical activity

Knowing about robotic prostate surgery side effects and how to manage them can greatly improve recovery. It’s vital for patients to talk about their concerns and any side effects with their healthcare provider.

Prostatectomy Robot: Surgical Outcomes and Cancer Control

Robotic prostatectomy has changed how we treat prostate cancer. It offers better surgery results and cancer control. The use of robotic technology makes the surgery more precise and effective.

Oncological Effectiveness

The success of robotic prostatectomy in fighting cancer is key. Research shows it works as well as, or better than, traditional surgery. The robot’s precision helps remove the prostate and nearby tissues more accurately.

Key benefits of robotic prostatectomy include:

  • Enhanced visualization and precision
  • Reduced blood loss and transfusion rates
  • Smaller incisions and improved cosmetic outcomes

Margin Status and Cancer Recurrence

The margin status is a key sign of surgery success. Robotic prostatectomy often has lower rates of cancer at the surgical edge. This could mean less chance of cancer coming back.

“The use of robotic systems in prostatectomy has been shown to reduce the risk of positive surgical margins, therefore potentially decreasing the likelihood of cancer recurrence.”

Long-Term Survival Rates Comparison

Looking at long-term survival rates is important for patients and doctors. Studies show robotic prostatectomy has similar or better long-term results than traditional surgery. The robot’s precision and less damage to the body might help achieve these good outcomes.

A study in the Journal of Urology found, “Robotic-assisted laparoscopic prostatectomy shows great long-term cancer control and survival rates. It’s a good treatment option for prostate cancer.”

Patient Selection Criteria for Robotic Prostatectomy

Robotic-assisted prostatectomy has many benefits. But choosing the right patients is key. Doctors look at the patient’s health, cancer details, and other factors before surgery.

Ideal Candidates for the Procedure

Good candidates have prostate cancer that’s only in the prostate. They usually have a prostate-specific antigen (PSA) level that’s not too high. And they must be in good health.

  • Men with past abdominal surgery might be okay, but it depends on their situation.
  • Those with serious heart disease or uncontrolled diabetes might need to get healthier first.

Contraindications and Risk Factors

Robotic prostatectomy is flexible, but there are limits. These include:

Contraindication/Risk FactorDescriptionImpact on Surgery
Severe ObesityMay make surgery harder to doCould lead to more problems
Previous Pelvic RadiationCan make tissues harder to work withMay make surgery longer and riskier
Large Prostate SizeRequires more skill and time to removeIt could make surgery longer

Age and Health Considerations

Age and health are big factors. Age isn’t a total no-go, but older folks might face more health issues. These could affect how well they recover.

Health considerations include checking the heart, kidneys, and other health areas. These can affect surgery success.

The surgery time can range from 2-4 hours. It depends on the case’s complexity and the surgeon’s skill.

Cost Analysis: Robotic vs. Traditional Prostate Surgery

It’s important for patients to understand the cost differences between robotic and traditional prostate surgery. The cost includes the surgery itself, hospital stay, and recovery time. These factors are key in making a decision.

Procedure and Hospital Costs

The cost of the surgery is a big factor. Robotic prostatectomy, often done with the Da Vinci Surgical System, is pricier than traditional surgery. This is because of the robotic tech’s high cost and the need for surgeon training. Hospital stays are shorter for robotic surgeries, but they add to the cost.

Despite higher operating room costs, robotic surgeries often have lower hospital stay costs. This is because they are shorter. 

Insurance Coverage Considerations

Insurance coverage is key in figuring out what patients will pay out of pocket. Most plans cover both types of surgeries, but coverage can vary. It’s important to check with your insurance to know what’s covered and what’s not.

Patients should talk to their healthcare provider about insurance to understand the financial side of their choice.

Long-Term Economic Impact Including Recovery

Robotic prostatectomy has a shorter recovery time than traditional surgery. This can save on costs like lost work time and post-op care. The long-term savings of robotic surgery can be big, even with higher upfront costs.

When looking at the cost of prostate surgery, patients should think about both immediate and long-term costs. Robotic surgery’s faster recovery and fewer complications make it a good choice for many.

Surgeon Experience and Training for Robotic Procedures

Robotic prostate surgery is a complex procedure. It needs a surgeon with a lot of skill. The surgeon’s experience greatly affects the surgery’s success and how well you recover.

Importance of Surgeon Volume and Experience

The surgeon’s skill and experience are key to a successful robotic-assisted prostatectomy. Research shows that surgeons who do more of these surgeries have better results. They have fewer complications and faster recovery times.

Surgeon volume matters a lot. It shows how familiar the surgeon is with the robotic system. Experienced surgeons can do the surgery more precisely and effectively.

Questions to Ask Your Surgeon About Their Training

When thinking about robotic prostate surgery, ask your surgeon about their training and experience. Here are some important questions:

  • How many robotic prostate surgeries have you performed?
  • What specific training have you received on the robotic system?
  • Can you share any outcomes or success rates from your previous robotic prostatectomies?

A study found that surgeons with over 100 robotic prostate surgeries had fewer complications and readmissions. This is compared to those with less experience.

“The learning curve for robotic prostatectomy is steep, but with extensive training and experience, surgeons can achieve outstanding results.”

Finding Experienced Robotic Surgeons

To find an experienced robotic surgeon, you can:

  1. Ask your primary care physician for recommendations.
  2. Check the surgeon’s credentials and certifications.
  3. Research online reviews and patient testimonials.

By doing these things, you can find a skilled surgeon for your robotic prostate surgery. This increases your chances of a successful surgery.

Making the Decision: Is Robotic Surgery Right for You?

When thinking about robotic prostatectomy, talking to a healthcare professional is key. You need to think about your health, the stage of your cancer, and what you want from surgery and recovery.

Weighing Personal Factors and Priorities

Think about your age, health, and how surgery might affect your life. Knowing the recovery time for robotic prostatectomy is also important. This helps you decide if it’s better than traditional surgery.

Also, consider how big your prostate cancer is. Your doctor can tell you if robotic surgery is right for you.

Discussing Options with Your Healthcare Team

Talking to your healthcare team is a big step. They can tell you the good and bad of robotic surgery. They’ll explain the average duration of robotic procedures and what recovery is like.

Ask about your surgeon’s experience with robotic surgery. Knowing how they handle side effects can help you decide.

FactorRobotic ProstatectomyTraditional Open Prostatectomy
Recovery TimeTypically shorter, with most patients returning to normal activities within 3-6 weeksGenerally longer, often requiring 6-12 weeks or more for full recovery
Surgical PrecisionEnhanced precision due to robotic assistanceDependent on the surgeon’s skill and experience
Blood LossTypically, less due to smaller incisions and robotic precisionIt can be significant due to a larger incision

Second Opinion Considerations

Getting a second opinion can give you more confidence. Ask about the surgeon’s robotic experience and how they handle complications. They can also give you a fresh view on your case.

A second opinion can help you decide if robotic surgery is best for you. It considers your unique situation and condition.

Patient Experiences and Satisfaction Rates

Patient feedback on robotic prostate surgery is mostly positive. Many say they recovered faster and felt less pain than with old methods. The use of advanced robotic tech in prostate surgery has made things better for patients, leading to higher satisfaction.

Quality of Life Outcomes

Research shows robotic prostate surgery improves patients’ lives. The surgery is less invasive, causing less tissue damage and trauma. This means less pain and quicker recovery times.

The Da Vinci Surgical System is often used for this surgery. It’s known for its precision. This helps keep nerves and tissues safe, which is key for keeping urinary and sexual functions after surgery.

Patient Testimonials and Satisfaction Surveys

Real-life stories and surveys show how well robotic prostate surgery works. Patients are very happy, thanks to the minimally invasive nature and rapid recovery times. They say it’s made a big difference in their lives, letting them get back to normal quickly.

  • Reduced post-operative pain
  • Shorter hospital stays
  • Quicker return to normal activities
  • Improved cosmetic outcomes due to smaller incisions

Psychological Aspects of Recovery

The mental side of recovering from robotic prostate surgery is important. Knowing they’re getting a modern, less invasive surgery reassures patients. Plus, the good results of robotic surgery help lower anxiety and stress during recovery.

Support from doctors, family, and friends is key to mental recovery. Many patients feel supported, which boosts their satisfaction with the surgery.

Conclusion: Is Robotic Prostate Surgery Better?

Robotic prostate surgery has changed how we treat prostate cancer. It’s a less invasive option compared to open surgery. The Da Vinci Surgical System is a key example of this technology used in prostate surgeries.

Recovery from robotic prostate surgery is usually quicker. Patients often have less blood loss, less pain, and smaller cuts. This means they can get back to their daily lives faster. But how fast you recover can depend on your health and the surgery’s complexity.

Robotic surgery has many advantages, like better precision and clearer views. But, it also has downsides like higher costs and a learning curve for surgeons. Whether it’s better for you depends on your situation and what you value most.

Knowing the pros and cons of robotic surgery helps patients make better choices. It’s important to talk to a doctor to find the best treatment for you.

FAQ

How long does robotic prostate surgery typically take?

Robotic prostate surgery usually lasts 2-4 hours. The exact time depends on the case’s complexity and the surgeon’s experience.

What is the recovery time for robotic prostatectomy?

Recovery from robotic prostatectomy is faster than traditional surgery. Most patients can return to normal activities in 2-4 weeks.

What are the benefits of robotic-assisted prostate surgery?

Robotic-assisted surgery offers many benefits. It provides better precision, less blood loss, smaller incisions, and less pain. This leads to a quicker recovery.

How does robotic prostate surgery compare to traditional surgery in terms of outcomes?

Robotic surgery has similar or better results than traditional surgery. It also reduces complications and speeds up recovery.

What are the possible side effects of robotic prostate surgery?

Side effects can include urinary issues and erectile dysfunction. But, with proper care, these can be managed.

How do I choose a qualified surgeon for robotic prostate surgery?

Look for a surgeon with robotic experience and good training. Check their complication rates and patient outcomes. Getting a second opinion is also wise.

What is the cost of robotic prostate surgery compared to traditional surgery?

Robotic surgery might cost more than traditional surgery. But it can save on hospital stay and recovery time, making it more cost-effective overall.

Can I expect to have a shorter hospital stay with robotic prostate surgery?

Yes, robotic surgery often means shorter hospital stays. Stays usually last 1-2 days, compared to traditional surgery.

How does the Da Vinci Surgical System work in robotic prostate surgery?

The Da Vinci System is a robotic platform. It allows surgeons to perform complex surgeries with better precision and dexterity. This improves surgery outcomes.

Are there any contraindications for robotic prostatectomy?

Certain conditions, like severe obesity or previous abdominal surgery, might make robotic prostatectomy unsafe. These conditions affect the procedure’s feasibility.

Reference:

  1. Patel, V. R., et al. (2025). The robotic revolution in cardiac surgery. Journal of Cardiothoracic Surgery, 17, Article 124. https://pmc.ncbi.nlm.nih.gov/articles/PMC12256362/
  1. Menon, M., et al. (2016). Robotic-Assisted Laparoscopic Radical Prostatectomy: Review of Outcomes and Current Status. Urologic Clinics of North America, 43(3), 407-414. https://pubmed.ncbi.nlm.nih.gov/27261915/

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