Robotic vs Open Surgery in Urologic Cancer: What Changes, and What Doesn’t
If you search “robotic surgery vs open surgery”, you’ll find a lot of confident claims. Some are broadly true. Some are selective. Some are marketing dressed up as certainty.
Robotic surgery is not a treatment in itself. It is a way of performing an operation—through small incisions—using a platform that can improve visualisation and instrument control in experienced hands. Open surgery is not “old fashioned”. It remains the best option in specific situations, and sometimes the safest operation is the one done through an incision.
This article explains what the evidence consistently shows across urologic cancer operations, what it does not reliably show, and how a judgement-led decision is made in real clinical practice in Australia.
Key takeaways
Robotic surgery is a minimally invasive approach to performing certain urologic cancer operations.
Across many procedures, it is often associated with less blood loss and a shorter hospital stay than open surgery—for appropriately selected patients and in established programs.
It does not guarantee better cancer control or better urinary/sexual outcomes.
Open surgery remains the safer choice in some cases. The best approach is the one that allows the right operation to be done well.
If you’d like a broader overview of how robotics is used across prostate, kidney and bladder cancer surgery (and what it does and doesn’t change), see Robotic Urologic Cancer Surgery.
First principles: “robotic” doesn’t mean the robot is operating
Robotic surgery is still surgeon-led surgery. The robot does not make decisions, interpret anatomy, or “do” the difficult parts while the surgeon watches.
What the platform can do is improve the surgeon’s ability to work precisely through small incisions—particularly when operating in tight spaces or when fine suturing and controlled dissection matter. That can be helpful. It can also be irrelevant, depending on the operation and the tumour.
In experienced hands, the value of robotics is not novelty—it is controlled execution of complex steps through a minimally invasive approach. The key is matching the platform to the right operation and patient, and being prepared to recommend an open approach when that is safer.
So the correct question is rarely “robotic or open?” in isolation. The correct questions are:
What is the right operation (or pathway) for this cancer?
Is a minimally invasive approach safe and appropriate in this patient?
Does the platform meaningfully help in this specific scenario?
Questions patients should ask (useful in consultations)
If you’re weighing robotic vs open surgery, these questions tend to produce the most useful answers:
What is the goal of treatment in my case (cancer control, organ preservation, function), and what are the trade-offs?
What factors in my case make minimally invasive surgery appropriate—or not?
If open surgery is recommended, what is the specific reason in my situation?
What does recovery typically look like for this operation?
What complications are most relevant for my health profile?
What supports are in place after surgery (rehabilitation, follow-up, monitoring, ERAS pathway where relevant)?
These questions shift the discussion away from the platform and back to the decision-making that drives outcomes.
What studies consistently show
Across radical prostatectomy, partial nephrectomy and cystectomy, comparative studies and meta-analyses commonly show that robot-assisted surgery is associated with:
lower average blood loss and lower transfusion rates
smaller incisions and fewer wound-related issues in some settings
shorter average hospital stay in established programs
The magnitude of these differences varies by operation, tumour complexity, and patient factors. Length of stay, in particular, is influenced by pain control, bowel recovery, mobility, complications, and home supports—not just incision size.
A minimally invasive approach can also allow a quicker return to day-to-day activities for some people early on, largely because there is less abdominal wall trauma. That is not the same as “back to baseline”, and recovery still varies widely.
What studies do not reliably show
Robotics does not guarantee better cancer control
Long-term cancer outcomes depend primarily on:
the biology of the cancer (grade, stage, behaviour),
accurate staging and appropriate pathway selection,
whether the correct operation was chosen,
and the quality and completeness of the cancer operation itself.
A platform can assist execution. It does not change the aggressiveness of the disease.
Robotics does not guarantee better functional outcomes
This matters most in prostate cancer, where patients worry about urinary control and erections.
Functional outcomes depend on:
baseline function before treatment,
cancer location and whether nerve-sparing is oncologically appropriate,
anatomy and tissue quality,
age and comorbidities (diabetes, vascular disease, smoking),
and recovery support (pelvic floor rehabilitation; sexual rehabilitation where appropriate).
For prostatectomy specifically: early urinary leakage is common, and continence recovery is multifactorial and time-dependent.
For the broader prostate cancer decision pathway—including active surveillance and radiation options—see Prostate Cancer.
Robotics does not remove complication risk
Minimally invasive surgery is still surgery. Complications can occur in either approach, and some complications have little to do with incision size.
For major operations (particularly cystectomy), key drivers of complications include frailty, comorbidity, nutritional status, baseline kidney function, prior abdominal surgery, prior radiation, tumour extent, diversion complexity, and the quality of peri-operative planning and recovery support.
The decision isn’t always surgery
A judgement-led pathway also includes recognising when surgery is not the best first step.
Depending on the cancer and risk profile, the right plan may be:
active surveillance (for selected low-risk prostate cancers and some small renal masses),
radiation-based treatment (for prostate cancer in particular),
systemic therapy as part of a multidisciplinary plan,
or bladder-preserving approaches in selected bladder cancer pathways.
“Robotic vs open” only becomes relevant after the right treatment pathway is clear.
When open surgery remains the better choice
Open surgery persists for good reasons. These are common scenarios where an open approach may be safer or more appropriate:
1) Advanced tumour extent or complex anatomy
If the cancer is locally advanced, invading adjacent structures, or requires a more extensive resection, open surgery may provide safer access and control.
2) Extensive prior abdominal surgery or dense adhesions
Prior major surgery can mean scar tissue and distorted anatomy. Sometimes minimally invasive surgery is still possible; sometimes it is not. The goal is choosing the safest route to complete the operation properly.
3) Prior radiation (selected scenarios)
Radiation can change tissue planes and healing. In some cases it increases complexity and risk. The best approach is individual and depends on the operation and the treatment history.
4) Patient factors where physiology matters
Minimally invasive surgery often involves specific positioning and abdominal insufflation (inflating the abdomen with gas), which can affect breathing and circulation. Severe cardiopulmonary disease or frailty can change what is safest.
5) The operation is technically better done open in that setting
There are scenarios where open surgery remains the most controlled option—particularly where immediate access, tactile feedback, or broader exposure matters.
This is not a failure of technology. It is judgement.
Procedure-by-procedure: where the differences tend to matter most
Prostate cancer surgery (radical prostatectomy)
Robotic prostatectomy is widely used. In many settings it is associated with smaller incisions, less blood loss on average, and shorter hospital stay.
But for outcomes that matter most to patients—cancer control, urinary control, erections—the platform is only one contributor. Baseline function, cancer factors, nerve-sparing appropriateness, anatomy, and post-operative support typically dominate.
For men and people with prostates who are weighing treatment options, the decision is often between surveillance, surgery and radiation-based pathways—each with trade-offs. (See the prostate cancer pathway page linked above.)
Kidney cancer surgery (partial or radical nephrectomy)
For kidney cancer, the key decision is often not “robotic vs open”. It is:
is surveillance safe,
is kidney-sparing surgery (partial nephrectomy) feasible and oncologically appropriate,
or is radical nephrectomy safer?
Robotic platforms can be particularly helpful for partial nephrectomy in selected cases because the operation often involves precise dissection and fine suturing around blood vessels and the collecting system (the urine drainage system of the kidney). But tumour complexity varies enormously, and open surgery remains appropriate in some high-complexity scenarios.
Bladder cancer surgery (radical cystectomy)
Cystectomy is major surgery regardless of approach.
Minimally invasive cystectomy can be associated with lower blood loss and shorter hospital stay in established programs, particularly when combined with enhanced recovery pathways (often called ERAS—enhanced recovery after surgery). But many outcomes—complications, recovery trajectory, the impact of urinary diversion—are dominated by patient factors and the overall pathway.
The platform is not the story. The pathway is the story.
For the broader bladder cancer pathway—including TURBT, non–muscle-invasive vs muscle-invasive disease, and bladder-preserving approaches—see Bladder Cancer.
Does surgeon experience and training matter?
It is reasonable to ask about experience and training—particularly for complex cancer operations.
Training pathways in urology vary. Some surgeons complete additional fellowship training in specific areas (for example, robotic urologic cancer surgery), and some build their experience through different combinations of mentorship, hospital programs and case mix. The point is not that there is one “correct” pathway. The point is that complex cancer surgery benefits from:
careful judgement about patient selection and staging,
consistency in technical execution,
a team and hospital pathway that supports safe recovery,
and honest discussion of trade-offs—including when an open approach is safer.
I completed additional fellowship training in robotic urologic cancer surgery before returning to Australia. Fellowship training matters because it involves a concentrated period of operating and decision-making in a high-volume setting, with close supervision and refinement of technique across complex cases. It also reinforces the less visible skill: recognising when the safest plan is not to use the robot, or not to operate at all.
If you are comparing options, it is appropriate to ask:
how often the surgeon performs the relevant operation,
how they decide between robotic and open in borderline situations,
what recovery pathway is used (including ERAS where relevant),
and how outcomes and complications are monitored and reviewed.
Clinical note
This article provides general information and is not a substitute for individual medical advice. Management should be based on personalised assessment, staging and discussion of options.
Last reviewed: January 2026
About the author
Dr Deanne Soares is a Melbourne-based urologist with a subspecialist focus in robotic prostate, kidney and bladder cancer surgery.
