A subsidiary of the University Medical Center Hamburg-Eppendorf

Roboterassistiert Da Vinci Konsole Schlaufen

Open or robotic-assisted surgery?

The Martini-Klinik uses both surgical techniques.

Complete removal of the prostate in open surgery 
The conventional technique is known as radical retropubic prostatectomy. In this method, the prostate is removed via a small incision in the lower abdomen. This operation is performed using microsurgical technology, including special loupes for magnification. 

Minimally invasive, robotic-assisted surgery 
This method is applied at the Martini-Klinik using the da Vinci® surgical system. The operating surgeon performs the procedure with the help of a robotic surgical system, which is fitted with microsurgical instruments and a camera system that provides a three-dimensional image. Four of the five operating theatres at the Martini-Klinik are now equipped with a robotic-assisted surgical system.

This makes it possible to tailor the surgical method to each patient’s specific clinical picture. Most patients are equally suitable candidates for both methods. 


Accompanies you through this topic

Prof. Dr. Alexander Haese
Faculty member

A direct comparison of open and robotic-assisted surgery

Let’s look at what a conventional radical prostatectomy and a robotic-assisted radical prostatectomy involve, and compare the two methods.

In the open surgical method, the surgeon accesses the prostate by making an 8 to 10 cm incision in the lower abdomen, above the pubic bone. In robotic-assisted surgery, the patient is placed in the lithotomy position, with their legs raised above their torso The prostate is accessed via six small incisions in the abdomen. The first small incision, just above the navel, allows the surgical team to fill the patient’s abdomen with carbon dioxide to improve their field of vision. A trocar (insertion aid) is then used to insert the camera through the incision, with further trocars placed in other incisions.

  • Open: One incision in the lower abdomen, 8 to 10 cm in length 
  • Robotic-assisted: 6 small incisions
  • Open: Standard position, lying horizontally 
  • Robotic-assisted: Lithotomy position, patient’s legs raised above their torso, abdomen filled with gas

The first phase of the operation involves carefully exposing the prostate. The two surgical methods differ in terms of the sequence of steps that follow. The open surgical method starts by detaching the prostate, which is embedded in the pelvic floor and the pelvic muscles. The robotic-assisted surgical method accesses the prostate from a different direction. The surgeon starts by detaching the urethra directly above the prostate, releasing the seminal vesicles and severing the seminal duct. It then detaches the prostate from the pelvic floor, pelvic muscles and the rectum.

The next step – if deemed reasonable from an oncological perspective – is nerve sparing. This time-consuming step is performed with great caution. Firstly, the powerful veins need to be ligated. The layer containing vascular and nerve tissue is separated from the prostate millimetre by millimetre. Special attention is paid to ensuring that no electrical energy or heat is applied in this step, as this could damage the sensitive nerves.

  • Open: Surgical loupes with 4x to 5x magnification
  • Robotic-assisted: 3D camera with 10x magnification

After completing the nerve-sparing step, the prostate is completely separated from the urethra. In doing so, the urethral sphincter is fully preserved using a technique developed by doctors at the Martini-Klinik in order to preserve the patient’s continence.

  • Open: Blood loss 550–750 mL, transfusion rate 3.5%
  • Robotic-assisted: Blood loss 150–250 mL, transfusion rate 1.5%

It is only medically possible to spare the nerves if it can be ascertained that the tumour has not extended beyond the capsule. It is not possible to determine this in the operating theatre without a microscope. This is why, during each prostatectomy at the Martini-Klinik, the removed prostate is sent to the pathology department and histologically examined using the NeuroSAFE technique – a technique that we developed and published. The bundle of nerve fibres is only removed if cancer cells are detected where the nerve fibres connect to the prostate.

Special surgical techniques used at the Martini-Klinik to preserve potency and continence

The urinary tract is then reconnected by suturing the urethra and the bladder neck together and then splinted with an indwelling catheter. The suture affects as little of the sphincter tissue as possible in order to preserve this muscle, which is responsible for continence.

In most but not all cases, a drainage tube is also inserted to remove exudate and lymphatic fluids. The abdominal incision, or the several small abdominal incisions, are then closed.

  • Open: Catheter remains in place for 12 days on average
  • Robotic-assisted: Catheter remains in place for 7 days on average

Nowadays, there is no significant difference in the duration of the two surgical methods.

  • Open: Surgery takes 175 minutes on average
  • Robotic-assisted: Surgery takes 195 minutes on average

The final step in the surgery is to close the wounds.

Vergleich ORP und RARP OP-Dauer

Surgery duration

The graph shows how surgery times have gone down in the eight years since the introduction of the robotic-assisted surgery method in 2008. The two curves have now almost converged.

Vergleich ORP und RARP Katheter

Time to catheter removal

The second graph shows how the length of time from surgery to catheter removal changed over the first eight years of use of the robotic-assisted surgical method. This is because the application of the sutures when reconnecting the bladder and the urethra can be visually monitored in robotic-assisted radical prostatectomy (RARP). This means we can be certain of the quality of the sutures, which in turn enables us to remove the catheter. 

Facts about continence and potency following open and robotic-assisted prostatectomy


At the Martini-Klinik, we rely on both surgical methods. As a rule, surgeons with the best possible training and experience are more likely to achieve successful outcomes in terms of preserving continence and potency. But which surgical method is right for you? In an initial consultation with you, your surgeon will examine whether there are medical criteria in favour of either method (such as the tumour stage, your physical constitution, any comorbidities, your age, etc.). As ever, we will ensure you have all the information you need to make your own decision.

You can choose elective services that are not medically necessary, such as the use of a robotic-assisted surgical system, regardless of your insurance status. We charge for such services separately; this co-payment will not be reimbursed by your health insurance provider.

More information

Conventional open prostatectomy
Robotic-assisted prostatectomy (da Vinci® surgical system)

What surgical methods are available for prostate cancer?

For treating prostate cancer via a radical prostatectomy, a distinction is drawn between two surgical techniques: open surgery and minimally invasive, robotic-assisted surgery.

Open surgery

The conventional method, open radical retropubic prostatectomy (RRP) is a surgical method that, through decades of use, has become the standard choice for the surgical treatment of clinically localised prostate carcinoma. This surgical method has been further developed, refined and improved over the years.

Minimally invasive, robotic-assisted surgery

The da Vinci® surgical system is a robotic-assisted system. It assists doctors in laparoscopic surgeries. Instead of making large incisions in the abdomen, small incisions are sufficient to insert the necessary instruments as well as a camera to provide an optimal, magnified view inside the patient.