Abstract
The treatment of prostate cancer has undergone a fundamental change in the last decade. New surgical and nonsurgical minimal invasive methods have evolved. As the methodology of the different treatments is commonly known to urologists, this article focuses on oncological and functional outcome of open retropubic (ORP), trans- or extraperitoneal endoscopical (LRP), and robot-assisted radical prostatectomy (RALP), based on personal experience and review of the literature. A MEDLINE search was performed to review the literature on LRP and RALP between 1982 and 2007 with special emphasis on oncological and functional results, technical considerations, comparison of LRP and RALP to ORP, laparoscopic training, historical aspects, and cost-efficiency of the techniques. Based on diligent training and proctoring programs, a continuous dissemination of laparoscopic techniques takes place. There is a trend towards the extraperitoneal access in most of the minimal invasive programs at least in the European community. Mid-term outcomes of LRP and short-term outcomes of RALP achieved equivalence to open surgery with regards to complications, oncologic and functional results. Distinct advantages of LRP include less postoperative pain, lower transfusion rates, shorter convalescence, and better cosmetics. In contrast to RALP, LRP reaches cost-equivalence with open surgery in selected centers. LRP and RALP reproduce the short-term results of open surgery while providing the advantages of a minimal access. Video-assisted teaching improves the transfer of anatomical knowledge and technical knowhow, but the discussion about the longer learning curve for laparoscopy handling remains. The future will show if European centers adopt the use of robots comparable to the United States.
Similar content being viewed by others
References
Walsh PC, Donker PJ (1982) Impotence following radical prostatectomy: insight into etiology and prevention. J Urol 128(3):492–497
Walsh PC, Lepor H, Eggleston JD (1983) Radical prostatectomy with preservation of sexual function: anatomical and pathological considerations. Prostate 157(5):1760–1767
Walsh PC (1998) Anatomic radical prostatectomy: evolution of the surgical technique. J Urol 160(6 Pt 2):2418–2424
Catalona WJ (1985) Nerve-sparing radical retropubic prostatectomy. Urol Clin North Am 12(1):187–199
Kirby R, Partin A, Feneley M, Parsons JK (2006) Prostate cancer: principles and practice. In: Robert PM and Arnauld V (eds) Chapter: anatomic considerations in radical prostatectomy. Informa Healthcare, Taylor & Francis, New York
Schuessler WW, Kavoussi LR, Clayman RV, Vancaille TH (1992) Laparoscopic radical prostatectomy: initial case report [abstract 130]. J Urol 147:246A
Schuessler W, Schulman P, Clayman R, Kavoussi L (1997) Laparoscopic radical prostatectomy: initial short-term experience. Urology 50:854–7
Raboy A, Ferzli G, Albert P (1997) Initial experience with extraperitoneal endoscopic radical retropubic prostatectomy. Urology 50(6):849–853
Guillonneau B, Cathelineau X, Barret E, Rozet F, Vallancien G (1999) Laparoscopic radical prostatectomy: technical and early oncological assessment of 40 operations. Eur Urol 36(1):14–20
Guillonneau B, Vallancien G (2000) Laparoscopic radical prostatectomy: the Montsouris technique. J Urol 63(6):1643–1649
Jacob F, Salomon L, Hoznek A, Bellot J, Antiphon P, Chopin DK, Abbou CC (2000) Laparoscopic radical prostatectomy: preliminary results. Eur Urol 37:615–620
Bollens R, Vanden Bossche M, Rhoumeguere Th, Damoun A, Ekane S, Hoffmann P, Zlotta AR, Schulman CC (2001) Extraperitoneal laparoscopic radical prostatectomy: results after 50 cases. Eur Urol 40:65–69
Rassweiler J, Sentker L, Seemann O, Hatziger M, Stock C, Frede T (2001) Heilbronn laparoscopic radical prostatectomy: technique and results after 100 cases. Eur Urol 40: 54–64
Stolzenburg JU, Do M, Pfeiffer H, Konig F, Aedtner B, Dorschner W (2002) The endoscopic extraperitoneal radical prostatectomy (EERPE): technique and initial experience. World J Urol 20(1):48–55
Salomon L, Sebe P, De la Taille A, Vordos D, Hoznek A, Yiou R, Chopin D, Abbou CC (2004) Open versus laparoscopic radical prostatectomy: part I. BJU Int 94(2):238–243
Stolzenburg JU, Truss MC, Do M, Rabenalt R, Pfeiffer H, Dunzinger M, Aedtner B, Stief CG, Jonas U, Dorschner W (2003) Evolution of endoscopic extraperitoneal radical prostatectomy (EERPE)-technical improvements and development of a nerve-sparing, potency-preserving approach. World J Urol 21(3):147–152
Rassweiler J, Seemann O, Schulze M, Teber D, Hatzinger M, Frede T (2003) Laparoscopic versus open radical prostatectomy: a comparative study at a single institution. J Urol 169(5):1689–1693
Gill I, Zippe C (2001) Laparoscopic radical prostatectomies: technique. Urol Clin North Am 28:423–428
Menon M, Shrisvastava A, Tewari A, Sarle R, Hemal A, Peabody JO, Vallancien G (2002) Laparoscopic and robot assisted radical prostatectomy: establishment of a structured program and preliminary analysis of outcomes. J Urol 168: 945–949
Binder J, Kramer W (2001) Robotically-assisted laparoscopic radical prostatectomy. BJU Int 87(4):408–410
Pasticier G, Rietbergen JB, Guillonneau B, Fromont G, Menon M, Vallancien G (2001) Robotically assisted laparoscopic radical prostatectomy: feasibility study in men. Eur Urol 40(1):70–74
Menon M, Tewari A, Peabody J (2003) Vattikuti Institute prostatectomy: technique. J Urol 169(6):2289–2292
Scardino PT (2005) Continuing refinements in radical prostatectomy: more evidence that technique matters. J Urol 173(2):338–339
Wieder JA, Soloway MS (1998) Incidence, etiology, location, prevention and treatment of positive surgical margins after radical prostatectomy for prostate cancer. J Urol 160(2):299–315
Tsuboi T, Ohori M, Kuroiwa K, Reuter VE, Kattan MW, Eastham JA, Scardino PT (2005) Is intraoperative frozen section analysis an efficient way to reduce positive surgical margins? Urology 66(6):1287–1291
Hull GW, Rabbani F, Abbas F, Wheeler TM, Kattan MW, Scardino PT (2002) Cancer control with radical prostatectomy alone in 1,000 consecutive patients. J Urol 167:528–534
Catalona WJ, Smith DS (1998) Cancer recurrence and survival rates after anatomic radical retropubic prostatectomy for prostate cancer: intermediate-term results. J Urol 160:2428–2434
Palisaar RJ, Noldus J, Graefen M, Erbersdobler A, Haese A, Huland H (2005) Influence of nerve-sparing (NS) procedure during radical prostatectomy (RP) on margin status and biochemical failure. Eur Urol 47(2):176–184
Han M, Partin AW, Pound CR, Epstein JI, Walsh PC (2001) Long-term biochemical disease-free and cancer specific survival following anatomic radical retropubic prostatectomy. Urol Clin North Am 28:555–565
Salomon L, Levrel O, de la Taille A, Anastasiadis AG, Saint F, Zaki S, Vordos D, Cicco A, Olsson LE, Hoznek A, Chopin D, Abbou CC (2002) Radical prostatectomy by the retropubic, perineal and laparoscopic approach: 12 years of experience in one center. Eur Urol 42(2):104–111
Roumeguere T, Bollens R, Vanden Bossche M, Rochet D, Bialek D, Hoffman P, Quackels T, Damoun A, Wespes E, Schulman CC, Zlotta AR (2003) Radical prostatectomy: a prospective comparison of oncological and functional results between open and laparoscopic approaches. World J Urol 20(6):360–652
Harris MJ (2003) Radical perineal prostatectomy: cost efficient, outcome effective, minimally invasive prostate cancer management. Eur Urol 44:303–308
Touijer K, Kuroiwa K, Vickers A, Reuter VE, Hricak H, Scardino PT, Guillonneau B (2006) Impact of a multidisciplinary continuous quality improvement program on the positive surgical margin rate after laparoscopic radical prostatectomy. Eur Urol 49(5):853–858
Chun FK, Graefen M, Zacharias M, Haese A, Steuber T, Schlomm T, Walz J, Karakiewicz PI, Huland H (2006) Anatomic radical retropubic prostatectomy-long-term recurrence-free survival rates for localized prostate cancer. World J Urol 24(3):273–280
Guillonneau B, el-Fettouh H, Baumert H, Cathelineau X, Doublet JD, Fromont G, Vallancien G (2003) Laparoscopic radical prostatectomy: oncological evaluation after 1,000 cases a Montsouris Institute. J Urol 169(4):1261–1266
Rassweiler J, Schulze M, Teber D, Seemann O, Frede T (2004) Laparoscopic radical prostatectomy: functional and oncological outcomes. Curr Opin Urol 14:75–82
Rassweiler J, Schulze M, Teber D, Marrero R, Seemann O, Rumpelt J, Frede T (2005) Laparoscopic radical prostatectomy with the Heilbronn technique: oncological results in the first 500 patients. J Urol 173(3):761–764
Lein M, Stibane I, Mansour R, Hege C, Roigas J, Wille A, Jung K, Kristiansen G, Schnorr D, Loening SA, Deger S (2006) Complications, urinary continence, and oncologic outcome of 1000 laparoscopic transperitoneal radical prostatectomies-experience at the Charite Hospital Berlin, Campus Mitte. Eur Urol 50(6):1278–82; discussion 1283–1284
Stolzenburg JU, Rabenalt R, DO M, Ho K, Dorschner W, Waldkirch E, Jonas U, Schutz A, Horn L, Truss MC (2005) Endoscopic extraperitoneal radical prostatectomy: oncological and functional results after 700 procedures. J Urol 174(4 Pt 1):1271–1275
Goeman L, Salomon L, La De Taille A, Vordos D, Hoznek A, Yiou R, Abbou CC (2006) Long-term functional and oncological results after retroperitoneal laparoscopic prostatectomy according to a prospective evaluation of 550 patients. World J Urol 24:281–288
Rassweiler J, Stolzenburg J, Sulser T, Deger S, Zumbe J, Hofmockel G, John H, Janetschek G, Fehr JL, Hatzinger M, Probst M, Rothenberger KH, Poulakis V, Truss M, Popken G, Westphal J, Alles U, Fornara P (2006) Laparoscopic radical prostatectomy–the experience of the German Laparoscopic Working Group. Eur Urol 49(1):113–119
Stolzenburg JU, Rabenalt R, Do M, Truss MC, Burchardt M, Herrmann TR, Schwalenberg T, Kallidonis P, Liatsikos EN (2007) Endoscopic extraperitoneal radical prostatectomy. The University of Leipzig experience of 1,300 cases. World J Urol
Wolfram M, Brautigam R, Engl T, Bentas W, Heitkamp S, Ostwald M, Kramer W, Binder J, Blaheta R, Jonas D, Beecken WD (2003) Robotic-assisted laparoscopic radical prostatectomy: the Frankfurt technique. World J Urol 21(3):128–132
Tewari A, Srivasatava A, Menon M (2003) Members of the VIP Team. prospective comparison of radical retropubic and robot-assisted prostatectomy: experience in one institution. BJU Int 92(3):205–210
Menon M, Tewari A, Peabody JO, Shrivastava A, Kaul S, Bhandari A, Hemal AK (2004) Vattikuti Institute prostatectomy, a technique of robotic radical prostatectomy for management of localized carcinoma of the prostate: experience of over 1100 cases. Urol Clin North Am 31(4):701–717
Menon M, Shrivastava A, Kaul S, Badani KK, Fumo M, Bhandari M, Peabody JO (2007) Vattikuti institute prostatectomy: contemporary technique and analysis of results. Eur Urol 51(3):648–658
Atug F, Castle EP, Srivastav SK, Burgess SV, Thomas R, Davis R (2006) Positive surgical margins in robotic-assisted radical prostatectomy: impact of learning curve on oncologic outcomes. Eur Urol 49(5):866–871
Atug F, Castle EP, Woods M, Srivastav SK, Thomas R, Davis R (2006) Transperitoneal versus extraperitoneal robotic-assisted radical prostatectomy: is one better than the other? Urology 68(5):1077–1081
Esposito M, Ahmed M, Dakwar G, Lanteri V (2006) Pure extraperitoneal laparoscopic robotic prostatectomy (EP-LRP): a large series experience. AUA abstract [1148]
Ahlering TE, Eichel L, Edwards RA, Lee DI, Skarecky DW (2004) Robotic radical prostatectomy: a technique to reduce pT2 positive margins. Urology 64(6):1224–1228
Slawin KM, Guariguata L (2006) The influence of increasing experience and surgical technique on surgical margin status in patients undergoing open and robotic prostatectomy by a single surgeon. AUA abstract [1164]
Zorn KC, Gofrit ON, Orvieto MA, Mikhail AA, Zagaja GP, Shalhav AL (2007) Robotic-assisted laparoscopic prostatectomy: functional and pathologic outcomes with interfascial nerve preservation. Eur Urol 51:755–763
Samadi D, Levinson A, Hakimi A, Shabsigh R, Benson MC (2007) From proficiency to expert, when does the learning curve for robotic-assisted prostatectomies plateau? The Columbia University experience. World J Urol
Joseph J, Rosenbaum R, Madeb R et al (2006) Robotic extraperitoneal radical prostatectomy: an alternative approach. J Urol 175:945–950
Ahlering TE, Patel V, Columbus OH, David IL, Philadelphia PA, Douglas S, Orange CA (2006) Multi-Institutional Review of Pathological Margins after Robot-Assisted Laparoscopic Prostatectomy (RLP). AUA abstract [1158]
Rozet F, Harmon J, Cathelineau X, Barret E, Vallancien G (2006) Robot-assisted versus pure laparoscopic radical prostatectomy. World J Urol 24(2):171–179
Patel VR, Tully AS, Holmes R, Lindsay J (2005) Robotic radical prostatectomy in the community setting: the learning curve and beyond: initial 200 cases. J Urol 174(1):269–272
Guillonneau B, Cathelineau X, Doublet JD et al (2002) Laparoscopic radical prostatectomy: assessment after 550 procedures. Crit Rev Oncol Hematol 43:123
Leandri P, Rossignol G, Gautier JR, Ramon J (1992) Radical retropubic prostatectomy: morbidity and quality of life. Experience with 620 consecutive cases. J Urol 147(3 Pt 2):883–887
Geary ES, Dendinger TE, Freiha FS, Stamey TA (1995) Incontinence and vesical neck strictures following radical retropubic prostatectomy. Urology 45(6):1000–1006
Eastham JA, Kattan MW, Rogers E, Goad JR, Ohori M, Boone TB, Scardino PT (1996) Risk factors for urinary incontinence after radical prostatectomy. J Urol 156(5):1707–1713
Davidson PJ, van den Ouden D, Schroeder FH (1996) Radical prostatectomy: prospective assessment of mortality and morbidity. Eur Urol 29(2):168–173
Feneley MR, Gillatt DA, Hehir M, Kirby RS (1996) A review of radical prostatectomy from three centres in the UK: clinical presentation and outcome. Br J Urol 78(6):911–8; 919–20
Talcott JA, Rieker P, Propert KJ, Clark JA, Wishnow KI, Loughlin KR, Richie JP, Kantoff PW (1997) Patient-reported impotence and incontinence after nerve-sparing radical prostatectomy. J Natl Cancer Inst 89:1117–1123
Bates TS, Wright MP, Gillatt DA (1998) Prevalence and impact of incontinence and impotence following total prostatectomy assessed anonymously by the ICS-male questionnaire. Eur Urol 33(2):165–169
Catalona WJ, Carvalhal GF, Mager DE, Smith DS (1999) Potency, continence and complication rates in 1,870 consecutive radical retropubic prostatectomies. J Urol 162:433–438
Kleinhans B, Gerharz E, Melekos M, Weingartner K, Kalble T, Riedmiller H (1999) Changes of urodynamic findings after radical retropubic prostatectomy. Eur Urol 35(3):217–222
Steiner MS (2000) Continence-preserving anatomical radical retropubic prostatectomy. Urology 55:427–435
Walsh PC, Marschke P, Ricker D, Burnett AL (2000) Patient reported urinary continence and sexual function after anatomic radical prostatectomy. Urology 55:58–61
Stanford JL, Feng Z, Hamilton AS, Gilliland FD, Stephenson RA, Eley JW, Albertsen PC, Harlan LC, Potosky AL (2000) Urinary and sexual function after radical prostatectomy for clinically localized prostate cancer: the Prostate Cancer Outcomes Study. JAMA 283:354
Kao TC, Cruess DF, Garner D, Foley J, Seay T, Friedrichs P, Thrasher JB, Mooneyhan RD, McLeod DG, Moul JW (2000) Multicenter patient self-reporting questionnaire on impotence, incontinence and stricture after radical prostatectomy. J Urol 163(3):870–871
Sullivan LD, Weir MJ, Kinahan JF, Taylor DL (2000) A comparison of the relative merits of radical perineal and radical retropubic prostatectomy. BJU Int 85(1):95–100
Artibani W, Grosso G, Novara G, Pecoraro G, Sidoti O, Sarti A, Ficarra V (2003) Is laparoscopic radical prostatectomy better than traditional retropubic radical prostatectomy? An analysis of peri-operative morbidity in two contemporary series in Italy. Eur Urol 44(4):401–406
Hoznek A, Salomon L, Olsson LE, Antiphon P, Saint F, Cicco A, Chopin D, Abbou CC (2001) Laparoscopic radical prostatectomy. The Creteil experience. Eur Urol 40(1):38–45
Türk I, Deger S, Winkelmann B, Schonberger B, Loening SA (2001) Laparoscopic radical prostatectomy. Technical aspects and experience with 125 cases. Eur Urol 40(1):46–53
Eden CG, Cahill D, Vass JA, Adams TH, Dauleh MI (2002) Laparoscopic radical prostatectomy: the initial UK series. BJU Int 90(9):876–882
Anastasiadis AG, Salomon L, Katz R, Hoznek A, Chopin D, Abbou CC (2003) Radical retropubic versus laparoscopic prostatectomy: a prospective comparison of functional outcome. Urology 62(2):292–297
Galli S, Simonato A, Bozzola A, Gregori A, Lissiani A, Scaburri A, Gaboardi F (2006) Oncologic outcome and continence recovery after laparoscopic radical prostatectomy: 3 years’ follow-up in a “second generation center”. Eur Urol 49(5):859–865
Ahlering TE, Skarecky D, Lee D, Clayman RV (2003) Successful transfer of open surgical skills to a laparoscopic environment using a robotic interface: initial experience with laparoscopic radical prostatectomy. J Urol 170(5):1738–1741
Begg CB, Riedel ER, Bach PB, Kattan MW, Schrag D, Warren JL, Scardino PT (2002) Variations in morbidity after radical prostatectomy. N Engl J Med 346(15):1138–1144
Bianco FJ Jr, Riedel ER, Begg CB, Kattan MW, Scardino PT (2005) Variations among high volume surgeons in the rate of complications after radical prostatectomy: further evidence that technique matters. J Urol 173(6):2099–2103
Takenaka A, Leung RA, Fujisawa M, Tewari AK (2006) Anatomy of autonomic nerve component in the male pelvis: the new concept from a perspective for robotic nerve sparing radical prostatectomy. World J Urol 24(2):136–143
Takenaka A, Tewari AK, Leung RA, Bigelow K, El-Tabey N, Murakami G, Fujisawa M (2007) Preservation of the puboprostatic collar and puboperineoplasty for early recovery of urinary continence after robotic prostatectomy: anatomic basis and preliminary outcomes. Eur Urol 51(2):433–440
Tewari A, Takenaka A, Mtui E, Horninger W, Peschel R, Bartsch G, Vaughan ED (2006) The proximal neurovascular plate and the tri-zonal neural architecture around the prostate gland: importance in the athermal robotic technique of nerve-sparing prostatectomy. BJU Int 98(2):314–323
Kaul S, Bhandari A, Hemal A, Savera A, Shrivastava A, Menon M (2005) Robotic radical prostatectomy with preservation of the prostatic fascia: a feasibility study. Urology 66:1261–1265
Graefen M, Walz J, Huland H (2006) Open retropubic nervesparing radical prostatectomy. Eur Urol 49:38–48
Stolzenburg JU, Rabenalt R, Do M, Tannapfel A, Truss MC, Liatsikos EN (2006) Nerve-sparing endoscopic extraperitoneal radical prostatectomy: University of Leipzig technique. J Endourol 20(11):925–929
Briganti A, Montorsi F (2006) Penile rehabilitation after radical prostatectomy. Nat Clin Pract Urol 3(8):400–401
Rabbani F, Patel MI, Scardino PT (2004) Time course of recovery of potency after bilateral nerve sparing radical prostatectomy. J Urol (suppl 171):310, abstract [1178]
Su LM, Link RE, Bhayani SB, Sullivan W, Pavlovich CP (2004) Nerve-sparing laparoscopic radical prostatectomy: Replicating the open surgical technique. Urology 64:123–127
Wagner A, Link R, Pavlovich C, Sullivan W, Su L (2006) Use of a validated quality of life questionnaire to assess sexual function following laparoscopic radical prostatectomy. Int J Impot Res 18(1):69–76
Ong AM, Su LM, Varkarakis I, Inagaki T, Link RE, Bhayani SB, Patriciu A, Crain B, Walsh PC (2004) Nerve sparing radical prostatectomy: Effects of hemostatic energy sources on the recovery of cavernous nerve function in a canine model. J Urol 172(4 pt 1):1318–1322
Lotan Y, Cadeddu JA, Gettman MT (2004) The new economics of radical prostatectomy: cost comparison of open, laparoscopic and robot assisted techniques. J Urol 172(4 Pt 1):1431–1435
Link RE, Su L-M, Sullivan W, Bhayani SB, Pavlovich CP (2005) Health related quality of life before and after laparoscopic radical prostatectomy. J Urol 173:175–179
Menon M, Shrivastava A, Tewari A (2005) Laparoscopic radical prostatectomy: conventional and robotic. Urology 66(5 Suppl):101–104
Poulakis V, Dillenburg W, Moeckel M, de Vries R, Witzsch U, Zumbe´ J, Rassweiler J, Becht E (2005) Laparoscopic radical prostatectomy: prospective evaluation of the learning curve. Eur Urol 47:167–175
Burgess SV, Atug F, Castle EP, Davis R, Thomas R (2006) Cost analysis of radical retropubic, perineal, and robotic prostatectomy. J Endourol 20(10):827–830
Author information
Authors and Affiliations
Corresponding author
Additional information
T. R. Herrmann and R. Rabenalt contributed equally to this article.
Rights and permissions
About this article
Cite this article
Herrmann, T.R., Rabenalt, R., Stolzenburg, J.U. et al. Oncological and functional results of open, robot-assisted and laparoscopic radical prostatectomy: does surgical approach and surgical experience matter?. World J Urol 25, 149–160 (2007). https://doi.org/10.1007/s00345-007-0164-9
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00345-007-0164-9