Understanding Robotic Assisted Laparoscopic Prostatectomy (RALP)

Prostate cancer is one of the most commonly diagnosed cancers in men, especially over the age of 50. Thankfully, modern surgical advancements have significantly improved treatment outcomes. One of the most effective techniques for treating localized prostate cancer is Robotic-Assisted Laparoscopic Prostatectomy (RALP).

RALP involves the removal of the prostate gland and seminal vesicles using robotic precision through small incisions. The approach prioritizes both cancer control and preservation of urinary and sexual function, while minimizing recovery time, discomfort, and complications.

Why Choose Dr. Avikar Singh at the Urology Institute

At the Urology Institute, Dr. Avikar Singh leads the robotic prostate cancer program using the state-of-the-art da Vinci Xi® surgical system—the latest and most advanced model in the da Vinci robotic platform.

Based at Busamed Gateway Private Hospital, this system allows for greater range of motion, 3D high-definition visuals, and unmatched surgical precision. With a global network of collaboration and years of hands-on expertise, Dr. Singh offers patients personalized care built on evidence-based practice, technological excellence, and compassionate guidance throughout their treatment journey.

How the da Vinci Xi® System Enhances Surgery

The da Vinci Xi system enhances robotic surgery with:

• High-definition 3D magnification for clear visualization of anatomy
• Miniaturized wristed instruments for delicate dissection and reconstruction
• Unmatched precision and range of motion, surpassing human capabilities
• Minimally invasive access, leading to faster recovery, less pain, and lower infection risks

This level of precision enables effective nerve-sparing techniques, essential for preserving continence and erectile function after prostate surgery.

Your Step-by-Step RALP Surgical Journey

1. Preoperative Consultation and Advanced Preparation

Every patient begins with a thorough consultation, where Dr. Singh explains the surgical plan, expected outcomes, and addresses all concerns. Based on the cancer stage and patient profile, the following imaging may be advised:

• Multiparametric MRI: Offers detailed images of the prostate to identify high-risk cancer zones and support nerve-sparing decisions.
• PSMA PET Scan: May be conducted in select patients to assess cancer spread and help with staging and treatment strategy.

Patients may also be asked to begin pelvic floor physiotherapy prior to surgery to strengthen the muscles responsible for urinary control. In addition, daily low-dose tadalafil (Cialis) may be initiated as part of penile rehabilitation to improve blood flow and support post-surgical erectile recovery.

Further pre-surgical steps include:

• Routine blood work and ECG
• Medication review and adjustment (especially anticoagulants)
• Fasting and procedural preparation instructions
• Lifestyle guidance (e.g., stop smoking, optimize physical activity)

2. Hospital Admission and Surgical Preparation

Patients are typically admitted to Busamed Gateway Private Hospital the night before or on the morning of surgery. Upon arrival:

• A hospital nurse will prepare an IV line
• You’ll be given a hospital gown and final instructions
• Consent and final checks will be completed before anesthesia

Inside the Operating Room: What Happens During RALP

Under general anesthesia, the procedure lasts 2 to 4 hours. Here’s a breakdown:

1. Five to six small incisions are made in the lower abdomen.
2. A robotic camera and surgical tools are inserted through ports.
3. Dr. Singh operates the robotic arms with high-precision controls.
4. The prostate and seminal vesicles are removed.
5. Nerve-sparing is prioritized when oncologically safe.
6. The bladder is reattached to the urethra to restore urinary function.
7. The site is checked for bleeding, then incisions are closed.

Postoperative Care and Recovery

Hospital Recovery (Most Discharged Within 48 Hours)

• Pain is minimal and managed with medication.
• A urinary catheter is placed during surgery and remains for 7–10 days.
• The care team assists with early ambulation and mobility.
• Most patients are discharged within 48 hours post-surgery.

Home Recovery Instructions

After discharge, follow a structured recovery plan:

• Wound and catheter care instructions provided
• Avoid lifting, straining, or sexual activity for 2–4 weeks
• Eat a high-fiber diet and stay hydrated to avoid constipation
• Perform light activities like walking to promote circulation

Before the catheter is removed, Dr. Singh may perform a retrograde urethrogram (RUG)—an imaging test to confirm that the bladder-urethra connection has healed properly. Only once this is confirmed is the catheter safely removed.

Life After Surgery: What to Expect Long-Term

Urinary Control

• Mild incontinence is common but usually improves within 3–6 months.
• Pelvic floor (Kegel) exercises significantly aid recovery.
• Most patients achieve full continence; few need long-term support.

Erectile Function

• Outcomes depend on age, pre-surgery function, and nerve preservation.
• Many regain satisfactory erectile function within 6–18 months.
• Recovery may involve continued tadalafil use, vacuum devices, or penile rehabilitation strategies.

Cancer Surveillance

• PSA (Prostate-Specific Antigen) levels are monitored regularly.
• An undetectable PSA usually confirms full cancer removal.
• Dr. Singh’s team schedules all necessary follow-ups and pathology reviews.

Benefits of Robotic-Assisted Laparoscopic Prostatectomy

Insurance Coverage and Financial Guidance

Most private medical aids in South Africa cover robotic prostatectomy (RALP) either fully or partially. Some insurers require:

• Pre-authorization
• Clinical documentation from your urologist
• Co-payments, depending on your plan

To make the process stress-free, Dr. Singh’s administrative team will:

• Contact your insurer directly
• Assist with authorizations and quotes
• Clarify out-of-pocket costs before your surgery

Frequently Asked Questions

1. Is RALP better than traditional open prostate surgery?

Yes. RALP is less invasive, more precise, offers faster recovery, and better long-term functional outcomes.

2. Will I regain urinary continence?

Most patients regain continence within 3–6 months. Kegel exercises and preoperative physiotherapy help significantly.

3. How long will I need a catheter?

7 to 10 days. A retrograde urethrogram may be performed before removal to ensure safe healing.

4. Will I be able to have sex again?

Yes. If nerves are preserved and you had good pre-surgery function, recovery is likely. Medications and rehabilitation may assist.

5. What if my cancer has spread?

If staging scans show spread, additional treatments such as radiation or hormone therapy may be needed after surgery.

6. Is this covered by medical insurance?

Yes, in most cases. Some plans may require co-payment. Speak with Dr. Singh’s office for details.

Take the Next Step with Confidence

Robotic-Assisted Laparoscopic Prostatectomy (RALP) offers the best of modern medicine—precision surgery, fast recovery, and superior outcomes. At the Urology Institute, Dr. Avikar Singh delivers this advanced care with empathy, skill, and support at every stage.

Book your consultation today at Busamed Gateway Private Hospital and begin your journey with confidence, clarity, and world-class care.