How Many Incisions Does Robotic Prostatectomy Require? A Complete Guide to Port Placement and Scarring

By Mr Neil A Haldar, Consultant Urological Surgeon | Last updated: April 2026

If you have been diagnosed with prostate cancer and are considering surgery, one of the most common questions I’m asked in clinic is how many robotic prostatectomy incisions are needed and what the scars look like afterwards. This guide answers both questions in detail, explains where each incision sits on your abdomen, and covers the modifications I make for taller patients, men with previous abdominal surgery, and those with other anatomical considerations.

Key facts at a glance

Standard robotic prostatectomy uses 5 to 6 small incisions, each measuring 8 to 12 mm (roughly the width of a pencil).
Single-port robotic prostatectomy uses just one 3 to 3.5 cm incision, typically placed near the belly button.
The largest incision in the standard approach is the camera port at 12 mm, usually extended slightly at the end to remove the prostate specimen.
All incisions sit below the level of the navel, arranged in a curved line across the lower abdomen.
Scars are small and fade well, often becoming barely visible at 12 months.
Port placement is tailored to the patient — body height, BMI, previous surgery, and pelvic anatomy all influence exactly where incisions are made.

How many incisions are used in robotic prostatectomy?

The standard robotic prostatectomy, performed with the da Vinci Xi or X surgical system, requires 5 to 6 incisions in total. The precise number depends on whether one or two assistant ports are used.

A newer platform called the da Vinci SP (single-port) allows the entire operation to be performed through a single 3 to 3.5 cm incision, sometimes with one additional small assistant port.

In my own practice, I use the standard multiport approach for the majority of cases, as it offers maximum flexibility and access. Single-port robotic prostatectomy is still a specialised technique available at only a small number of UK centres.

Where are the incisions placed?

In the standard multiport approach, the six ports are arranged in a shallow arc across the lower abdomen, all below the level of the umbilicus. A typical configuration is as follows:

Port	Size	Location	Purpose
Camera port	12 mm	Midline, at or just above the umbilicus	Inserts the 3D endoscope
Robotic arm 1	8 mm	Left paramedian, ~8 cm from the camera	Articulating instrument arm
Robotic arm 2	8 mm	Right paramedian, ~8 cm from the camera	Articulating instrument arm
Robotic arm 3	8 mm	Left anterior axillary line	Retraction and dissection
Assistant port 1	12 mm	Right lower quadrant	Suction, suture passing, clip application
Assistant port 2 (optional)	5 mm	Right lateral	Additional retraction

A key technical principle is that port placement is referenced to the pubic bone rather than the belly button. The da Vinci robotic arms have a maximum working reach of around 25 cm, so every port must sit within 18 cm of the pubic symphysis to allow the instruments to reach the urethra deep within the pelvis. In taller men, this means all ports are shifted noticeably lower than they would be in a man of average height.

How big are the incisions?

The individual incisions in standard robotic prostatectomy are genuinely small:

Four robotic arm ports: 8 mm each (less than 1 cm)
One or two assistant ports: 5 to 12 mm
Camera port: 12 mm, extended to approximately 3 to 5 cm at the end of the operation to remove the prostate specimen

For comparison, traditional open radical prostatectomy uses a single vertical incision running from the pubic bone to the umbilicus, typically 12 to 15 cm long.

How is the prostate removed through such small incisions?

The prostate is sealed inside a specimen retrieval bag during the operation and then extracted at the end through an enlarged camera port incision. The umbilical incision is usually extended to 3 to 5 cm, or an Alexis wound retractor is used to gently stretch the opening during specimen removal.

Some surgeons choose to make this extraction incision transverse (horizontal) rather than vertical, as transverse incisions have been associated with lower rates of incisional hernia and generally heal with a more cosmetically acceptable scar.

Single-port robotic prostatectomy: how does it differ?

The da Vinci SP system is designed specifically for single-incision surgery. All robotic instruments and the camera pass through one flexible multi-channel port placed through a single incision.

Two main approaches are used:

Extraperitoneal single-port RARP — a 3 to 3.5 cm midline incision placed approximately 2 cm below the umbilicus.
Transperitoneal single-port RARP — a 3 to 3.5 cm supraumbilical incision, positioned about 20 cm from the pubic bone.
Transvesical single-port RARP — a novel 3.5 cm infraumbilical incision with no additional ports at all; the robot works directly inside the bladder.

An optional 10 to 12 mm assistant port in the right lower quadrant may be added if extra retraction is needed.

Single-port surgery is not universally better than multiport surgery. It offers a smaller total wound area and potentially faster recovery in selected patients, but it is technically more demanding and has a steeper learning curve. The evidence on whether functional outcomes (continence and potency) differ meaningfully between the two approaches is still evolving.

Which patients need modified incision placement?

Not every patient receives a standard port configuration. Several factors prompt me to alter the approach:

Tall patients (over 183 cm / 6 feet)

Because port reach is constrained by the 25 cm limit of the robotic arms, taller men need all ports shifted caudally (towards the feet) to stay within 18 cm of the pubic bone. Using the umbilicus as the reference in a tall man risks placing the ports too high to reach the urethra.

Obese patients (BMI ≥ 30, especially ≥ 40)

A thicker abdominal wall distorts the relationship between surface landmarks and deep anatomy. Operative times are longer, and for very obese patients, an extraperitoneal approach is often preferred because it requires less steep head-down (Trendelenburg) positioning, which is safer for the lungs and for intraocular pressure.

Previous abdominal or pelvic surgery

Robotic prostatectomy remains feasible after most previous abdominal operations, but the approach may need tailoring:

Previous bowel surgery (colectomy, J-pouch) — an extraperitoneal, transvesical, or transperineal approach may be chosen to avoid entering the peritoneal cavity altogether, eliminating the need for adhesion division.
Previous laparoscopic inguinal hernia repair with mesh — preperitoneal mesh significantly complicates the dissection. Survey data suggest nearly half of urologists find subsequent prostatectomy more difficult, and around 16% have had to abandon the operation. Careful preoperative discussion is essential.
Previous appendectomy — usually requires only minor adhesion division and does not typically alter port placement.

Umbilical hernia

A pre-existing umbilical hernia can often be incorporated into the camera port site, allowing the hernia to be reduced, the fascial defect used for access, and the hernia repaired during specimen extraction — effectively two operations in one.

Small pelvis

In smaller-framed patients with a narrow pelvic inlet, the lateral ports may need to be placed more medially and caudally to avoid interference with the bony pelvis.

Previous radiotherapy or BPH surgery

Neither directly changes the incision locations, but both make the operation technically more challenging because the normal tissue planes are obscured by fibrosis (after radiotherapy) or altered by previous prostate procedures (after TURP or simple prostatectomy). Salvage prostatectomy after radiotherapy is among the most demanding operations in urology.

Rectus diastasis

A widening of the midline abdominal wall greater than 2 cm is an independent risk factor for incisional hernia after robotic prostatectomy. In these patients, a transverse extraction incision is generally preferred over a vertical midline one.

What do the scars look like at 12 months?

The cosmetic outcome of robotic prostatectomy is generally excellent. The 8 mm port sites heal as small dots, often barely visible once the initial pink discolouration fades over 6 to 12 months. The camera port incision — the longest scar — is usually 3 to 5 cm and sits at or just above the umbilicus, where it is naturally camouflaged by the navel itself.

By comparison, the 12 to 15 cm vertical midline scar of open prostatectomy is always clearly visible.

How does port placement affect recovery?

The small size of robotic incisions translates directly into important clinical advantages:

Shorter hospital stay — most men go home the day after surgery; at The Princess Grace Hospital most of my private patients are home within 24 to 36 hours.
Lower postoperative pain — robotic surgery is associated with significantly lower pain scores than both open and conventional laparoscopic approaches.
Faster return to normal activity — most men return to light activity within 2 weeks and full activity by 6 weeks.
Lower blood loss — average blood loss is around 150 ml, and transfusion is required in only about 2% of cases.
Lower hernia risk than traditional open surgery, with a 3-year incisional hernia rate of 5.4% (robotic) versus 9.5% (open).

Common questions about robotic prostatectomy incisions

How many incisions are made in a robotic prostatectomy?

Standard robotic prostatectomy uses 5 to 6 small incisions, each measuring 8 to 12 mm. The configuration includes one camera port, three or four robotic arm ports, and one or two assistant ports, all arranged in a curved line below the umbilicus. Newer single-port (da Vinci SP) systems require only one 3 to 3.5 cm incision.

How big are the scars after a robotic prostatectomy?

The 8 mm port sites typically heal as small dots, often barely visible by 12 months once the initial pink discolouration fades. The camera port incision, which is extended to 3 to 5 cm to remove the prostate, sits at or just above the umbilicus, where it is naturally camouflaged by the navel.

Where are the incisions placed during robotic prostatectomy?

All incisions sit below the level of the umbilicus, arranged in a shallow arc across the lower abdomen. Port placement is referenced to the pubic bone rather than the belly button, with all ports kept within 18 cm of the pubic symphysis to ensure the robotic instruments can reach the urethra. In taller men, ports are shifted noticeably lower than in men of average height.

Will I have a catheter coming out of one of the incisions?

No. The urinary catheter passes through the penis (urethra), not through the abdominal wall. You will typically also have a single small drain emerging from a separate stab incision, which is usually removed before you go home.

Are robotic prostatectomy incisions painful after surgery?

Most patients describe the discomfort as manageable with simple painkillers such as paracetamol and a short course of stronger analgesia. The small size of the wounds means pain is substantially less than with traditional open surgery, and robotic surgery is associated with significantly lower pain scores through 12 weeks postoperatively.

What is single-port robotic prostatectomy?

Single-port robotic prostatectomy uses the da Vinci SP system to perform the entire operation through one 3 to 3.5 cm incision, typically placed near the umbilicus. All robotic instruments and the camera pass through a single flexible multi-channel port. It offers a smaller total wound area but is technically demanding and available at only a few UK centres.

How soon after robotic prostatectomy can I shower?

Most patients can shower 24 to 48 hours after surgery, once the dressings have been removed. Bathing and swimming are usually deferred until the wounds are fully healed, typically at 2 weeks.

Can the robotic prostatectomy incisions be made smaller for cosmetic reasons?

The incisions are already close to the minimum size needed to accommodate the robotic instruments. Cosmetic preferences can sometimes be accommodated — for example, a transverse rather than vertical extraction incision — but patient safety and cancer clearance always take priority over cosmesis.

What are the risks from the incisions themselves?

Wound infection is uncommon (under 2%). Port-site hernia is the most relevant long-term wound complication and can occur at the larger port sites, particularly the camera port. Careful fascial closure at the end of the operation minimises this risk. The 3-year incisional hernia rate after robotic prostatectomy is approximately 5.4%, lower than the 9.5% rate after open surgery.

Does my body type affect where the incisions are placed?

Yes. Tall patients (over 183 cm) need ports shifted caudally to stay within the robotic arm’s working reach. Obese patients (BMI ≥ 30) may benefit from an extraperitoneal approach. Men with previous abdominal surgery, umbilical hernias, or small pelvic dimensions all receive modified port configurations tailored to their anatomy.

The bottom line

Robotic prostatectomy achieves a major cancer operation through a handful of keyhole incisions — five to six small wounds of 5 to 12 mm, or a single 3 to 3.5 cm incision with newer single-port technology. The exact configuration is tailored to each patient’s height, body habitus, prior surgery, and pelvic anatomy.

For most men, the visible trace of the operation at one year is a few small dots across the lower abdomen and a short scar near the belly button. The surgical precision this affords — combined with the speed of recovery — is why robotic surgery has become the dominant approach to radical prostatectomy in both the NHS and the private sector.

Book a consultation

If you have been diagnosed with prostate cancer and would like to discuss whether robotic prostatectomy is right for you, my secretary Emma Stacey can arrange a consultation at the Chiltern Hospital (Great Missenden) or other Thames Valley locations.

Contact: 07841 048975

About the author

Mr Neil A Haldar is a Consultant Urological Surgeon and Urology Cancer Lead at Buckinghamshire Healthcare NHS Trust. He started the da Vinci robotic prostatectomy surgery programme at Buckinghamshire NHS Trust and specialises in robotic and laparoscopic urological surgery, uro-oncology, and paediatric urology. He trained at King’s College School of Medicine and holds an MD from the Nuffield Department of Surgery, University of Oxford.