Radical Prostatectomy (Robotic-Assisted)

CPT 55866
Approach Minimally Invasive
Add-on / Variant CPTs
  • 55862 — Radical prostatectomy, with bilateral pelvic lymphadenectomy
  • 55842 — Radical prostatectomy, retropubic (open)
Preoperative Diagnosis:

Prostate adenocarcinoma — [Gleason X+X=X / Grade Group X], clinical stage [T2a–T3b], PSA [X] ng/mL

Postoperative Diagnosis:

Same

Procedure Performed:

Robotic-assisted laparoscopic radical prostatectomy (RALP) — [nerve-sparing bilateral / nerve-sparing unilateral right / non-nerve-sparing] [with bilateral pelvic lymph node dissection]

Attending Surgeon:

[Attending name], MD/DO

First Assistant:

[Resident/PA name]

Anesthesia:

General endotracheal

Indications:

The patient is a [age]-year-old [male/female] with biopsy-proven prostate adenocarcinoma, Gleason [X+X=X], Grade Group [X], PSA [X] ng/mL, clinical stage [T2/T3]. Multiparametric MRI demonstrated [lesion at X / seminal vesicle invasion / extracapsular extension]. The risks, benefits, and alternatives including radiation therapy, active surveillance, and hormonal therapy were discussed and informed consent was obtained.

Findings:

The prostate was [mobile / with limited extracapsular extension at the [right / left] posterolateral base]. The seminal vesicles were [normal in size / with invasion at the tip]. [Nerve-sparing was feasible / was not feasible given [extracapsular extension / positive MRI at the neurovascular bundle].] Bilateral [/ extended] pelvic lymph node dissection yielded [X] nodes. The vesicourethral anastomosis was watertight on confirmation.

Description of Procedure:

The patient was positioned supine in [steep Trendelenburg (25°)]. The robotic system was docked. A [12-mm] camera port was placed at the umbilicus. [5] additional robotic/assistant ports were placed in standard configuration.

The peritoneum was incised and the space of Retzius was developed. The bladder was mobilized anteriorly. [Extended bilateral pelvic lymph node dissection was performed, removing nodal tissue from the external iliac, obturator, and [internal iliac / hypogastric] regions bilaterally.]

The endopelvic fascia was incised bilaterally. The dorsal venous complex (DVC) was [suture-ligated / stapled]. The bladder neck was incised anteriorly and the plane between bladder neck and prostate was developed. The posterior bladder neck was divided and the vasa deferentia were clipped and divided. The seminal vesicles were dissected free.

[Nerve-sparing: The neurovascular bundles were preserved bilaterally [/ unilaterally] using a [retrograde / antegrade] nerve-sparing technique with [cold scissors / bipolar energy used sparingly]. Fascia was preserved over the NVBs.]

The urethra was divided sharply at the prostatic apex. The prostate and seminal vesicles were placed in an Endocatch bag. The vesicourethral anastomosis was constructed with running [3-0 V-Loc] suture, [6 stitches posterior then anterior]. Anastomosis was confirmed watertight with [200] mL irrigation. A [16 Fr] urethral catheter was placed.

The Endocatch bag was extracted through the camera port incision. The fascia was closed with [0-Vicryl]. Skin was closed with [4-0 Monocryl].

Complications:

None

Specimens:

Radical prostatectomy specimen (prostate + seminal vesicles) — sent to pathology with orientation ink. Pelvic lymph nodes bilateral — sent separately.

Estimated Blood Loss:

[X] mL

Drains:

[19 Fr Blake drain in pelvis] / None

Disposition:

The patient was taken to the PACU in stable condition. The urethral catheter was left in place. The patient was ambulatory on postoperative day 1. The drain was removed when output was [<50 mL/day]. The catheter was removed at [7–14 days] on post-operative visit.

Epic SmartPhrase Version 
PREOPERATIVE DIAGNOSIS: Prostate adenocarcinoma — Gleason ***, Grade Group ***, PSA ***
POSTOPERATIVE DIAGNOSIS: Same
PROCEDURE PERFORMED: RALP — *** nerve-sparing [+ bilateral PLND]
ATTENDING: ***, MD/DO
ASSISTANT: ***
ANESTHESIA: General

INDICATIONS: .PTAGE-year-old .PTSEX with prostate cancer Gleason ***, PSA ***, stage ***. Consent obtained.

FINDINGS: Prostate ***. SV ***. NVB ***. PLND: *** nodes bilateral.

PROCEDURE:
Supine, steep Trendelenburg 25°. Robot docked. Camera umbilicus, *** ports. Space of Retzius developed. [PLND: ext iliac, obturator, [int iliac] bilateral.] Endopelvic fascia incised. DVC ***. Bladder neck incised anterior/posterior. Vas deferens clipped/divided. SV dissected. [Nerve-sparing: NVBs preserved bilateral/unilateral, cold scissors, fascia preserved.] Urethra divided at apex. Specimen in Endocatch bag. VUA with running 3-0 V-Loc, *** stitches. Watertight: 200 mL irrigation confirmed. Foley 16 Fr. Specimen extracted. Closed.

EBL: *** mL
SPECIMENS: Prostatectomy specimen + LNs to pathology
COMPLICATIONS: None
DISPOSITION: PACU. Ambulatory POD 1. Catheter out day ***.

Signed: .ME, .MYDEGREE
.TODAY
Variants

Open Retropubic Radical Prostatectomy

An open retropubic approach was used via a [lower midline / Pfannenstiel] incision. The space of Retzius was developed. Bilateral pelvic lymph node dissection was performed. The DVC was suture-ligated. The bladder neck was divided. Nerve-sparing was performed bilaterally with sharp dissection. The vesicourethral anastomosis was constructed with [6] interrupted [2-0 Vicryl] sutures. Open approach provides tactile feedback and is appropriate for anatomically challenging cases or in settings without robotic access.

Charting Tips
  • Document nerve-sparing status and technique. Nerve-sparing approach is associated with better continence and potency outcomes. Document whether NVBs were spared (bilateral, unilateral, or non-sparing) and the technique (intrafascial, interfascial, extrafascial). This guides post-operative expectations and rehabilitation.
  • Document pelvic lymph node dissection template. Extended PLND (including internal iliac nodes) yields more nodes and better staging but carries higher lymphocele risk. Document the template performed and node count from each side.
  • Document anastomosis water-tightness testing. The vesicourethral anastomosis must be tested by filling the bladder with saline before closing. Document 'no leak at [200 mL] irrigation.' Unrecognized leaks at the anastomosis are a major source of post-operative complications.
Billing Tips
  • 55866 (laparoscopic/robotic-assisted radical prostatectomy, 21.90 wRVU) covers minimally invasive radical prostatectomy regardless of robotic platform. No separate robotic modifier is used.
  • Open retropubic radical prostatectomy: 55840 (without lymph node dissection, 20.83 wRVU), 55842 (with limited pelvic LND, 20.83 wRVU), 55845 (with bilateral extended LND, 24.55 wRVU).
  • Pelvic lymph node dissection: when performed laparoscopically/robotically, 38571 (laparoscopic bilateral pelvic LND) is separately billable in addition to 55866. Document extent of dissection.
  • Nerve-sparing documentation (unilateral vs bilateral, intrafascial vs interfascial) is clinically required and supports post-op functional outcome coding. Include in operative note.
  • Global period is 90 days. Post-op catheter management, PSA monitoring, and pad counts are bundled. Urethral dilation or cystoscopy for anastomotic stricture within 90 days uses modifier -79 (unrelated) or -78 (complication).
  • Robotic assistant facility charges (HCPCS S2900) are billed by the facility, not the surgeon. The surgeon bills the same CPT whether open or robotic.
  • Document: clinical stage, Gleason score, pre-op PSA, nerve-sparing status, bladder neck reconstruction technique, and anastomosis method. These support oncologic accuracy and quality metrics.