What does robotic prostatectomy look like? Is it like a vasectomy?

This week I watched a video of a complete robotic prostatectomy procedure in Italy. It was on a medical education site for doctors. What a long drawn out complicated procedure! It took one hour 46 minutes of continuous resection, not including initial setup. They used 6 ports and had tiny scissors in the right hand that could also cauterize by passing high frequency AC current through them, with a grounding pad attached to the patient's skin. Tiny sparks and smoke can be seen. This is the same as the Bovie scalpel they have used to minimize bleeding during surgery since 1926. They also used a small clamp in the left hand, and it could be used for bipolar cauterization where current is passed from one half of the clamp, through to the other half of the clamp. Larger vessels were clamped with plastic clips.

With these devised blood loss was fairly minimal but suction was used to keep the surgical field clear and the surgeon had a pretty good view. The degree of magnification could be adjusted. During endoscopic surgeries they can pump in carbon dioxide gas to create an open cave to work in.

The urethra passes right through the prostate and a section about 5 to 8 cm long (1 to 1.5 inches) had to be removed with the prostate. It is amazing that they can simply sew the two ends of the urethra back together with dissolving sutures. They pass a Foley catheter through the urethra so that it can be clearly identified, and it is used to align the two parts of the urethra during suturing. The spermatic ducts also have to be cut, giving the same results as a vasectomy. Of course it is a much bigger surgery than vasectomy.

My wife is a retired embryologist and they sometimes did a wedge resection of a testicle to try to recover a few sperm in men who wanted IVF after a surgery like this, or after a vasectomy. The embryologist had to go fishing under a powerful binocular microscope, catch a sperm, cut off its tail before it could swim away, suck it into a tiny glass tube and then inject it into an ovum. Incubated it for a few days until it divided into about 8 cells before implanting it in the uterus.

They also had men provide a semen sample to freeze in liquid nitrogen before surgery so that it could be used for IVF later. You have to pay rental to keep the sample frozen.