How to cite: Davis JW. Robotic-Assisted Radical Prostatectomy (RARP). Grand Rounds in Urology. February 2026. Accessed Oct 2026. https://grandroundsinurology.com/robotic-assisted-radical-prostatectomy-rarp/
Summary
John W. Davis, MD, FACS, Professor of Urology and Director, Urosurgical Prostate Program, University of Texas MD Anderson Cancer Center, Houston, Texas, presents a recorded robotic-assisted radical prostatectomy using a multiport robotic system, illustrating surgical decision-making, anatomical landmarks, and technical strategies used during robotic prostate cancer surgery.
The operation begins with entry into the space of Retzius and exposure of the bladder and prostate. Dr. Davis highlights how patient anatomy, body habitus, and prior abdominal surgery can influence adhesions and operative access. He emphasizes the importance of controlled dissection and traction techniques rather than excessive cutting, noting that correct tissue tension often reveals the natural surgical plane.
The bladder neck is divided while maintaining orientation to the surrounding vascular structures. Posterior dissection proceeds toward the seminal vesicles, where careful control of arterial branches is necessary to prevent delayed bleeding. Bipolar energy and clips are used selectively depending on vessel size and proximity to neurovascular structures.
Dissection of the neurovascular bundles requires progressive pedicle control and careful preservation of surrounding functional tissues. Dr. Davis discusses variations in nerve-sparing strategies and the importance of minimizing thermal injury during these steps.
The apex dissection focuses on preserving urethral length to improve postoperative continence outcomes. After division of the urethra, the specimen is removed, and the vesicourethral anastomosis is performed using a running barbed suture. Posterior reconstruction techniques help reduce tension and support anastomosis.
Throughout the demonstration, Dr. Davis reflects on the evolution of prostatectomy from open surgery to laparoscopy and robotic platforms, highlighting improvements in visualization, hemostasis, and reconstructive precision. The recorded format provides insight into real operative challenges, surgical preferences, and training considerations for robotic prostatectomy.
The International Prostate Cancer Update (IPCU), is a multi-day, CME-accredited conference focused on new developments in prostate cancer treatment, diagnosis, and prevention. IPCU 36 featured lectures, interactive discussions, panel roundtables, debates, and case reports. This conference is led by expert physicians and is designed for urologists, medical oncologists, radiation oncologists, and other healthcare professionals involved in the diagnosis and treatment of prostate cancer.The goal of this educational program is to equip healthcare professionals involved in the diagnosis and treatment of prostate cancer with the up-to-date clinical knowledge and tools they need to best treat their patients. The program will discuss the treatment of prostate cancer from diagnosis to treating advanced and metastatic disease. The conference aims to give physicians exposure to a comprehensive review of treating prostate cancer patients and to give them a chance to discuss the issues with peers and experts.
ABOUT THE AUTHOR
John W. Davis, MD, is a Professor of Urology and Director of the Urosurgical Prostate Program at the University of Texas MD Anderson Cancer Center in Houston, Texas. He received his BS in Biology at Davidson College in North Carolina in 1990. He then went on to earn his medical degree at the University of Virginia in 1994 and completed his residency training at Eastern Virginia Graduate School of Medicine in Norfolk, Virginia. Dr. Davis had fellowship training in prostate cancer research in the Department of Microbiology and Molecular Cell Biology at Eastern Virginia Medical School, and received an American Foundation of Urologic Disease Scholar award for proteomic applications in prostate cancer biomarkers. He completed a Clinical Fellowship in Urologic Oncology at the MD Anderson Cancer Center, and a Fellowship in Laparoscopic Urology at Charité Hospital in Berlin, Germany, under the mentorship of Ingolf Tuerk.
Dr. Davis’ clinical interests include patients with urologic cancers, laparoscopic/robotic surgery, and general urology. His academic interests include quality of life after prostate cancer treatment, outcomes for robotic radical prostatectomy, high-risk prostate cancer trials, active surveillance for prostate cancer, and development of robotic surgical techniques for invasive bladder cancer. He has participated as an investigator in several Southwest Oncology Group and industry-sponsored clinical trials.
