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Kolkata: HCG Cancer Hospital Kolkata recently performed a Robot-Assisted Radical Prostatectomy (RARP) for a 68-year-old gentleman, who had been diagnosed with an aggressive form of prostate cancer. He had earlier undergone a TURP with Laser BNI at another hospital to relieve urinary blockage, during which the cancer was detected. The biopsy revealed a Gleason score of 4+3, pointing to a high-risk disease that demanded advanced care. Following this, he turned to the specialists at HCG Cancer Hospital Kolkata, where Dr. Gaurav Aggarwal, HOD & Sr. Consultant, Uro-Oncology & Robotics, led the surgery — a case made more challenging by his previous procedure.
(TURP, or Transurethral Resection of the Prostate, is a procedure where prostate tissue is removed through the urinary passage to relieve urinary blockage. Laser BNI stands for ‘Bladder Neck Incision using Laser,’ a procedure done alongside TURP to carefully widen the bladder neck, helping urine flow more easily and relieving urinary blockage. It is commonly done for men with enlarged prostate. However, if prostate cancer is later detected, it makes further surgery—like robotic prostatectomy—much more complex.)
With a confirmed diagnosis, the patient sought opinions from several uro-oncologists in the city before coming to Dr. Gaurav Aggarwal, HOD & Sr. Consultant, Uro-Oncology & Robotics, at HCG Cancer Hospital Kolkata. He was also guided by Dr. Suvraraj Das, Junior Consultant, Uro-Oncology, who is part of Dr. Aggarwal’s team. After thorough evaluation and counselling, options of Radiotherapy and a Robot-Assisted Radical Prostatectomy (RARP) were discussed. A shared decision making between his family and the medical team was done and he opted for RARP.
Robot-Assisted Radical Prostatectomy (RARP) is a minimally invasive surgery to remove the prostate gland and surrounding tissues using robotic arms controlled by a surgeon. The robotic system provides a magnified 3D view, high precision and better dexterity, which helps in preserving nerves, reducing blood loss, and promoting faster recovery, compared to traditional open surgery. Performing RARP after a previous TURP is particularly challenging because the earlier procedure alters the normal anatomy, making it harder to identify critical structures like the ureteric openings and increasing the technical difficulty of the surgery, due to dense surrounding adhesions.
The surgery was performed smoothly without complications. Remarkably, Mr. Ramesh was walking the very next day and discharged on the third day after surgery, with minimal discomfort.
The patient is now on regular follow-up as per the standard international guidelines, with PSA checks every few months, and continues to recover well.
Dr. Gaurav Aggarwal said, “Performing RARP in patients who have already undergone procedures like TURP or Laser BNI is extremely challenging. The prior surgery often alters the anatomy, making critical landmarks difficult to identify. In this case, the bladder neck and urethral junction were particularly distorted. However, the robotic platform gave us magnified 3D visualization and precise control, allowing us to carefully dissect tissues, preserve the ureteric openings, and achieve cancer clearance. It required advanced planning and meticulous execution, but we were able to deliver a safe and successful outcome.”
Dr. Suvraraj Das, Junior Consultant, Uro-Oncology, HCG Cancer Hospital Kolkata, added “As part of the treating team, our focus was on ensuring the patient felt fully informed and supported through each step. Robot-assisted surgery not only addressed the disease effectively but also helped in preserving his quality of life, which is equally important in cancer care.”
Sharing his experience, the gentleman said, “After my earlier procedures, I was very nervous about undergoing another major surgery. But Dr. Aggarwal explained everything clearly and assured me that robotic surgery would be safe. The recovery was much faster than I had imagined, and I am grateful to the entire HCG team for giving me a new lease of life.”
This case not only highlights the complexity of performing robotic surgery after prior interventions like TURP but also demonstrates how HCG Kolkata’s expertise in uro-oncology and robotics is pushing the boundaries of what is possible in prostate cancer care in India.
