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Robotic-Assisted Laparoscopic Prostatectomy: Do Minimally Invasive Approaches Offer Significant Advantages?

Joseph A. Smith, Jr, S. Duke Herrell

From the Vanderbilt University Medical Center, Department of Urologic Surgery, Nashville, TN

Address reprint requests to Joseph A. Smith Jr, MD, Vanderbilt University Medical Center, Department of Urologic Surgery, A 1302 Medical Center N, Nashville, TN 37232-2765; e-mail: joseph.smith{at}vanderbilt.edu.

Radical prostatectomy has maintained a cardinal role in the treatment of localized prostate cancer. Robotic-assisted laparoscopic prostatectomy (RALP) has been introduced as a less invasive surgical approach. Available data on RALP versus open approaches were reviewed for surgical and cancer related outcomes. RALP is consistently associated with decreased blood loss and limited postoperative pain and hospital stay. Surgical margins seem similar between most reported series of RALP or open radical prostatectomy. Most intrainstitutional comparisons demonstrate better postoperative continence and potency with RALP, but there is still debate about whether results are superior to radical retropubic prostatectomy in the hands of a highly experienced surgeon. RALP provides outcomes at least comparable, and, in some measures, superior to open surgery. Refinements of instrumentation may provide even better results in the future.

Authors' disclosures of potential conflicts of interest are found at the end of this article.

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