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Open, laparoscopic or robotic prostatectomy: what actually differs | CION Cancer Clinics
Open, laparoscopic and robotic prostatectomy all remove the prostate, the seminal vesicles and sometimes the lymph nodes, and all rejoin the bladder to the urethra. What differs is how the surgeon gets there. Keyhole approaches mean less blood loss and a shorter stay; open surgery costs less and suits some men better. Cancer control and long-term recovery come out much the same in trials. CION Cancer Clinics’ surgical oncologists in Hyderabad can talk this through with you.
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Medically reviewed by Dr. Muralidhar MuddusettyConsultant Surgical Oncologist · MBBS (AIIMS), MS (Surgery, AIIMS), DNB (Surgical Oncology), MRCS (Edinburgh) · last reviewed September 2026, next review due September 2027
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On this page
- What is the real difference between open, laparoscopic and robotic prostatectomy?
- How each one reaches the prostate
- Open and keyhole prostatectomy, compared
- Four things families tell us about robotic surgery
- Who each approach does not suit
- How to ask your centre which approach they use, and why
- Words you will meet, in plain language
- Common questions about the three approaches
The short answer
What is the real difference between open, laparoscopic and robotic prostatectomy?
All three remove the same organs in the same way. The difference is how the surgeon reaches the prostate: through one larger cut, through small cuts with hand-held keyhole instruments, or through small cuts with instruments driven from a console. Inside the body the steps are the same.
What the studies so far show
Trials comparing open and robotic surgery have found that how well the cancer is removed, and how urine control and erections recover over the longer term, come out much the same. Robotic and laparoscopic surgery usually mean less blood loss, less pain in the first days and a shorter hospital stay. Open surgery costs less and does not depend on a machine.
What matters more than the approach
The surgeon's experience with the approach they use has a larger effect on your result than the approach itself. A surgeon who does open prostatectomy every week will usually do better than one doing an occasional robotic case. Ask how many they do, and which they do most.
This page compares the three approaches in general. It cannot tell you which one your own surgeon should use for you.The three approaches
How each one reaches the prostate
Open prostatectomy
One cut from below the navel to the pubic bone. The surgeon sees and feels the gland directly. It is the longest-established approach and the one every other approach is measured against.
Often chosen when
- The gland is very large
- There has been previous pelvic surgery
- No robot is available at the centre
Laparoscopic prostatectomy
Several small cuts. A camera and long, straight instruments go in through them, and the surgeon works while watching a screen. Keyhole surgery done by hand.
Often chosen when
- The centre has keyhole skill but no robot
- Cost of the robot is a barrier
Robotic prostatectomy
The same small cuts, but the instruments are held by robotic arms that the surgeon controls from a console in the same room. The wrists of the instruments turn further than a hand can, and the view is magnified.
The robot does nothing on its own. Every movement is the surgeon's.Side by side
Open and keyhole prostatectomy, compared
Open
Keyhole (laparoscopic or robotic)
One cut, usually a hand's length
Five or six small cuts across the belly
More blood loss; a transfusion is sometimes needed
Less blood loss; transfusion is uncommon
A longer hospital stay and more pain early on
A shorter stay and less early pain
Cancer control much the same in trials
Cancer control much the same in trials
Lower cost; no machine needed
Higher cost, highest with the robot
Not sure whether this applies to you?
Ask an oncologistCommonly believed
Four things families tell us about robotic surgery
"The robot does the operation, so the surgeon matters less."
The robot only copies the surgeon's hand movements. It has no judgement of its own. Which tissue to cut, whether the nerves can be kept and how the join is stitched are all the surgeon's decisions, made in the moment.
"Robotic surgery removes the cancer more completely."
Trials have not shown that. The rate of cancer left at the cut edge, and the chance of the PSA rising later, are similar across approaches when surgeons of similar experience are compared.
"With the robot, urine control and erections come back straight away."
Recovery of both takes months whichever approach is used. Early recovery may be a little quicker with keyhole surgery, but the longer-term results in trials are much the same.
"Open surgery is old-fashioned and unsafe."
Open prostatectomy is still done by experienced surgeons every day, and for some men it is the safer choice. A large gland, scar tissue from earlier surgery or the need to convert mid-operation all favour it.
Being straight with you
Who each approach does not suit
Keyhole surgery needs the belly to be filled with gas and the body tilted head-down for a few hours. Men with severe lung disease, some heart conditions or raised pressure in the eye may not tolerate that safely, and an open operation is chosen instead. Heavy scarring from earlier abdominal surgery can also make keyhole access unsafe.
When the surgeon changes plan mid-operation
Occasionally a keyhole operation is converted to open once the surgeon sees the tissue. This is a safety decision, not a failure, and you should be told before surgery that it can happen. Ask how often it happens in your surgeon's hands.
What the approach cannot change
No approach changes the grade of your cancer, whether it has already spread beyond the gland, or the state of your erections and bladder before surgery. Those three things shape your recovery far more than the choice of instruments. If the cancer sits close to the nerve bundles, the nerves may need to be taken whichever approach is used.
Before you decide
How to ask your centre which approach they use, and why
Ask what they do most
How many prostatectomies does the surgeon do a year, and by which approach? A surgeon experienced in one approach is a better sign than a centre that owns the newest machine.
Ask why that approach for you
Your gland size, past surgery, lung and heart health and where the cancer sits should all come into the answer. A one-word answer is not enough.
Ask about conversion
If keyhole is planned, ask what would make them switch to open during the operation, and how that changes the stay and the bill.
Ask for the estimate in writing
Robotic instruments add a per-case cost that some schemes and insurers do not fully cover. Get the figure for the approach planned, and what Aarogyasri, CGHS, ECHS, EHS or your insurer will pay.
On your consent form
Words you will meet, in plain language
- Laparoscopic
- Keyhole surgery done with hand-held instruments through small cuts, guided by a camera.
- Robot-assisted
- Keyhole surgery where the instruments are held by machine arms that the surgeon controls from a console. The surgeon is in the room.
- Port
- Each small cut, with a short tube through which an instrument or the camera passes.
- Conversion
- Changing from keyhole to open surgery part-way through, for safety or because the view is not good enough.
- Retropubic
- The usual route for open surgery, reaching the prostate through the lower belly, behind the pubic bone.
- Blood loss
- Recorded for every operation. Higher loss means a higher chance of a transfusion, which is one reason keyhole approaches are preferred where they are safe.
Questions we are asked
Common questions about the three approaches
Is robotic prostatectomy safer than open?
Not in the sense most people mean. Serious complications are uncommon with all three approaches in experienced hands. Keyhole surgery does mean less blood loss and a lower chance of needing a transfusion, and a shorter stay. Open surgery avoids the head-down tilt and gas, which matters for some men with lung or heart disease.
Does CION do robotic surgery?
Which approaches are available depends on the centre and the surgeon, and it changes over time. Rather than promise one here, we would ask you to call the helpline and tell us what has been found so far. We will connect you to a surgical oncologist who can say what is available for your case and why.
Will the scar be much smaller with the robot?
Yes, several small scars instead of one long one. One of the small cuts is made a little larger to lift the gland out. Scars are rarely the reason to choose an approach, though. Blood loss, your general health and the surgeon's experience count for more.
Is laparoscopic surgery the same as robotic?
Both are keyhole. In laparoscopic surgery the surgeon holds the instruments by hand; in robotic surgery machine arms hold them and the surgeon controls them from a console. Robotic instruments bend further and the view is magnified, which many surgeons find easier, but the operation inside is the same.
How much longer is the stay with open surgery?
Usually a day or two longer, though this varies between centres more than between approaches. What decides your stay is how quickly you are walking, eating and managing pain. With any approach you go home with the catheter in and return to have it removed.
Can nerve-sparing be done with all three?
Yes. Whether the nerves can be kept depends on where the cancer sits, not on the instruments. Surgeons who use the robot say the magnified view helps them see the nerve layer, but experienced open surgeons spare nerves routinely as well. Ask your surgeon what they expect for your case.
Why does robotic cost so much more?
The machine is expensive to buy and maintain, and each operation uses instruments that are discarded after a set number of uses. Those costs are passed into the bill. A shorter stay claws back a little, but not all of it. Some schemes pay a fixed package that does not cover the robotic top-up.
What if I want open surgery but the centre only offers robotic?
Say so, and ask why they recommend the robot for you. If the reasons are sound, that is useful to know. If you are not satisfied, a second opinion from a surgeon who does open prostatectomy is a fair request. No good surgeon is offended by it.
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Dr. C. Raghavendra Reddy
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Dr. Bharati Devi Gorantla
MBBS, MD(General Medicine), DM(Medical Oncology)(Adyar,Chennai), ECMO, MRCP SCE(UK)
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Dr. Owais Mohammed
MBBS, MD (General Medicine), DrNB (Medical Oncology), ECMO, MRCP SCE (Medical Oncology) (UK)
Medical Oncologist
Medical Oncologist
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Dr. Muralidhar Muddusetty
MBBS (AIIMS), MS (Surgery) (AIIMS), DNB (Surgical Oncology), MRCS (Edinburgh)
Surgical Oncologist
Surgical Oncologist
Surgical Oncologist
Dr. Vinay Mamidala
MBBS, MS(General Surgery), M.Ch(Surgical Oncology), FMAS, FARIS(Ongoing)
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Hematologist
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Dr. Vajja Sandeep Kumar
MBBS, MS (General Surgery), DrNB (Surgical Oncology), FALS Oncology
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Sources
- Cancer Research UK — Surgery for prostate cancer
- American Cancer Society — Surgery for prostate cancer
- NHS — Prostate cancer: treatment
- NICE — Prostate cancer: diagnosis and management (NG131)
- National Cancer Institute — Prostate cancer treatment (PDQ), patient version
This page is general information, not a prescription. Do not change or stop any treatment based on what you read here. If anything is worrying you, contact your own treating team — or call our helpline and we will help you reach the right specialist.
Keep reading
Related pages
Is Robotic Prostatectomy Worth the Extra Cost?What the extra money does and does not buyRadical Prostatectomy: What the Operation InvolvesWhat is removed and rejoined, whichever approach is usedNerve-Sparing Prostatectomy ExplainedKeeping the nerves is about position, not the instrumentsChoosing a Surgeon and a CentreThe questions that tell you more than the equipment list
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Weighing up which approach is right for you?
Tell us what has been found so far and we will connect you to a surgical oncologist who can explain which approach they would use for your case, and why. One helpline serves every CION centre.