Last updated: March 2026
When a patient receives a diagnosis of localised prostate cancer, one of the first things they search for is "robotic surgery". And they are right to do so: robot-assisted radical prostatectomy is today the standard surgical treatment for localised prostate cancer at most leading centres worldwide.
But not all robotic prostatectomies are the same. The surgical technique, the surgeon's experience, and the philosophy of anatomical preservation determine whether the patient, in addition to being cured of cancer, will retain urinary continence and sexual function. In this article, I explain what we do at ICUA and why our results are what they are.
What is robotic urological surgery?
Robotic surgery is not performed by a robot. It is performed by a surgeon seated at a console, controlling articulated arms that replicate his movements with precision that exceeds that of the human hand. The Da Vinci system — which is what we use at Clínica CEMTRO — offers magnified three-dimensional vision, instruments with a 360-degree range of movement, and tremor elimination. This enables more precise dissection of the structures surrounding the prostate: the erectile nerves, the urinary sphincter, and the bladder neck.
The result is a surgery that combines the oncological radicality of open surgery with minimal invasiveness: sub-centimetre incisions, minimal bleeding, a 2–3 day hospital stay, and rapid recovery.
Radical prostatectomy by lateral approach: the technique we use
Several techniques exist for performing robot-assisted radical prostatectomy. At ICUA, we use the lateral approach, a technique developed by Dr. Richard Gaston in Bordeaux, France, which differs from conventional approaches in several fundamental respects.
What does the lateral approach involve?
Rather than approaching the prostate from the front — dissecting the space of Retzius and dividing the dorsal venous complex — the lateral approach accesses the prostate from the side, through a lateral "buttonhole". This allows:
- Complete preservation of the anterior pubovesical complex: the anatomical structure connecting the bladder to the pubic bone, containing muscle fibres and nerves critical for continence and potency. In conventional techniques, this structure is partially or completely divided.
- Direct access to the seminal vesicle: without needing to mobilise anterior structures, allowing cleaner dissection of the vascular pedicles and neurovascular bundles.
- Minimal use of thermal energy: the nerves are dissected bluntly (without heat), avoiding thermal damage that can cause temporary or permanent erectile dysfunction.
The incision is longitudinal — like a "buttonhole" — less disruptive than the transverse incisions of other techniques across the fibres of the anterior complex.
The collaboration with Dr. Richard Gaston
Dr. Gaston is one of the pioneers of robotic urological surgery in Europe and the creator of this technique. Our collaboration began over 16 years ago. I learned the technique directly from him, working side by side through hundreds of procedures. It was not a weekend course or an online video — it was direct, case-by-case learning with the inventor of the procedure.
This relationship has continued over the years. Dr. Gaston has operated regularly at Clínica CEMTRO as part of our team, and together we have built the experience that underpins our published results.
Our published results: 513 patients
In 2023, we published our complete series of radical prostatectomy by lateral approach in the journal Cancers (Rodríguez Socarrás et al., 2023). The study includes 513 consecutive patients operated between January 2015 and March 2021 by two surgeons: Dr. Gaston (289 patients) and Dr. Gómez Sancha (224 patients). The primary endpoint was reproducibility — demonstrating that a second surgeon can achieve results equivalent to those of the technique's creator.
Urinary continence (completely dry, no pad):
At catheter removal (day 0): 86% and 85%
At 1 month: 93% and 91%
At 1 year: 96% and 98%
Sexual potency (satisfactory intercourse):
At 3 months: 60% and 66%
At 1 year: 73% and 72%
Oncological control:
Significant positive surgical margins (>2 mm): 5.9% and 7.6% (p = 0.67 — no statistical difference)
Biochemical recurrence: 11.7% and 12%
Positive lymph nodes: 4.5% and 4.9%
Safety:
Clavien III/IV complications: 3.8% and 2.2%
Transfusion: 3.1% and 2.2%
Mean hospital stay: 2.8 and 3.3 days
No statistically significant difference between the two surgeons in any oncological, functional, or complication parameter.
These results deserve context. According to data from specialised tertiary centres, approximately half of patients report erectile dysfunction before radical prostatectomy, 80% are continent at catheter removal, and only 53% recover full sexual function. Our immediate continence rate of 85–86% (completely dry, no pad whatsoever) and potency at one year of 72–73% place our series in the upper range of published results worldwide.
What does "reproducible" mean?
It means that the results of Dr. Gómez Sancha, having learned the technique from Dr. Gaston, are statistically equivalent to those of the technique's creator. This is significant because it demonstrates that the technique does not depend on unrepeatable individual talent but on clear anatomical principles that, with appropriate training, can be taught and reproduced. The Kaplan–Meier curves for continence, potency, and biochemical recurrence show no significant difference between the two surgeons.
When is robot-assisted radical prostatectomy indicated?
Radical prostatectomy is a treatment for localised prostate cancer. It is not a treatment for benign prostatic hyperplasia (that is what HoLEP is for). The main indications are:
- Localised prostate cancer (stages T1–T2) with a life expectancy of at least 10 years.
- Selected locally advanced cancer (T3a) in appropriate patients.
- Patients who prioritise definitive treatment over active surveillance or radiotherapy.
The decision between surgery, radiotherapy, and active surveillance is complex and must be individualised. In our clinic, we use the Madrid Protocol — a combination of multiparametric MRI, fusion biopsy, and micro-ultrasound — to characterise the tumour with maximum precision before recommending treatment. This allows us to plan a personalised surgery: deciding whether to spare one or both neurovascular bundles, how much margin to take at each site, and adapting the technique to the exact tumour location.
Other robotic procedures at ICUA
Although radical prostatectomy is the most common robotic procedure, at ICUA we perform the full spectrum of robotic urological surgery:
- Robotic partial nephrectomy: for kidney tumours, preserving the maximum amount of healthy renal tissue.
- Robotic radical cystectomy: for invasive bladder cancer.
- Reconstructive procedures: pyeloplasty, ureteral reimplantation, and pelvic floor surgery.
Technology and team at Clínica CEMTRO
We operate with the latest-generation Da Vinci Xi system, with AirSeal insufflation for stable, comfortable pneumoperitoneum. The surgical team comprises surgeons with specific experience in the lateral approach, anaesthetists specialising in robotic urological surgery, and dedicated nursing staff.
Clínica CEMTRO is a leading private hospital in Madrid with over 30 years of track record and comprehensive hospital infrastructure: ICU, blood bank, advanced diagnostic imaging, and histopathology laboratory.
At ICUA we offer a comprehensive assessment and personalised surgery with published results.
📞 +34 91 435 28 44 · ✉ icua@icua.es
Scientific references
- Rodríguez Socarrás M, Gómez Rivas J, Reinoso Elbers J, ..., Gastón R, Gómez Sancha F. Robot-Assisted Radical Prostatectomy by Lateral Approach: Technique, Reproducibility and Outcomes. Cancers. 2023;15:5442. DOI
- Asimakopoulos AD, Annino F, D'Orazio A, et al. Complete Periprostatic Anatomy Preservation During RALP: The New Pubovesical Complex-Sparing Technique. Eur Urol. 2010;58:407-417. DOI
- Rodríguez Socarrás ME, Gómez Rivas J, Cuadros Rivera V, et al. Prostate Mapping for Cancer Diagnosis: The Madrid Protocol. J Urol. 2020;204:726-733. DOI
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