Radical Prostatectomy: Respective Roles and Comparisons of Robotic and Open Surgeries

Young Deuk Choi; Jae Seung Chung

doi:10.5124/jkma.2010.53.2.119

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Choi and Chung: Radical Prostatectomy: Respective Roles and Comparisons of Robotic and Open Surgeries

Focused Issue of This Month

Prostate Cancer

Journal of the Korean Medical Association

Journal of the Korean Medical Association 2010; 53(2): 119-125.

Published online: 28 February 2010

DOI: https://doi.org/10.5124/jkma.2010.53.2.119

Radical Prostatectomy: Respective Roles and Comparisons of Robotic and Open Surgeries

Young Deuk Choi, MD, Jae Seung Chung, MD

Department of Urology, Yonsei University College of Medicine, Korea. youngd74@yuhs.ac

Abstract

Over the years, several surgical modifications have been incorporated into radical prostatectomy in order to improve the surgical outcome. Despite the rapid dissemination of robot-assisted laparoscopic prostatectomy (RALP) through the urologic community, comparative studies on the practicality of RALP compared to open radical prostatectomy (OP) are lacking. Thus, it remains difficult to draw any conclusions regarding cancer control and postoperative morbidity. This review will introduce the evolution of surgical technique and the current status of RALP in relation to OP in the management of localized prostate cancer focusing on the perioperative, oncological and functional outcomes. Based on the review of literatures, perioperative outcomes, such as blood loss, transfusion rates, hospitalization duration and complication rates, all favored RALP. The positive surgical margin rates of RALP were similar to those of OP with regard to the oncological outcomes. With regard to the functional outcomes, OP and RALP also showed similar continence and potency rates. However, refinements in technique employed during RALP have improved the early return of continence postoperatively. Although OP remains the gold standard treatment in localized prostate cancer, robotic surgery and continued technical advancements will ultimately improve patient outcomes. However, further prospective randomized comparative clinical trials with a long-term follow-up utilizing validated questionnaire are needed to prove the superiority of either surgical approach in terms of functional and oncological outcomes. In addition, RALP technique will need a substantial decrease in the cost of the robotic system to achieve wider global acceptance and application.

Keywords: Prostate cancer, Prostatectomy, Robotics, Urinary incontinence, Erectile dysfunction

Figures and Tables

Figure 1

The da Vinci S Surgical system.

Figure 2

A) The position of port placement in extraperitoneal robotic radical prostatectomy.

B) The position of port placement in transperitoneal robotic radical prostatectomy.

Table 1

Perioperative outcomes of open radical prostatectomy (OP) and robot-assisted laparoscopic radical prostatectomy (RALP)

Table 2

Oncological and functional outcomes of open radical prostatectomy(OP) and robot-assisted laparoscopic radical prostatectomy (RALP)

^‡, ^*: p < 0.05, ^†: 3-mo continence rate, ^‡: The median time to continence, ^*: The median time to erectile function recovery

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