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Robot-Assisted Radical Prostatectomy

  • Bernardo Rocco
  • Rafael Ferreira Coelho
  • Ahmed Eissa
  • Maria Chiara Sighinolfi
  • Ahmed Elsherbiny
  • Ahmed Zoeir
  • Giovanni Pellacani
  • Vipul R. Patel
Chapter

Abstract

In the field of oncologic urologic surgery, robot-assisted radical prostatectomy (RARP) represents the main application of the robotic approach. RARP is currently the leading urologic use of the da Vinci system, and more than 75% of the radical prostatectomies performed in North America were carried out by robot-assisted surgery. Indications for RARP are the same with those for radical retropubic prostatectomy (RRP), and RARP has also been described as a salvage surgical treatment after radiotherapy (RT), brachytherapy, and high-intensity focused ultrasound. Under an oncological point of view, RARP offers at least the same results of RRP also in higher-risk patients. Extended lymph node dissection yielding a reasonably high number of lymph nodes is feasible during RARP. The mean complication rate of RARP is 9% (range, 3–26%). Twelve-month urinary incontinence rates after RARP range from 4% to 31%, with significant advantage in favor of RARP in comparison with RRP and laparoscopic radical prostatectomy. RARP is associated with an incidence of 12- and 24-month erectile dysfunction ranging from 10% to 46% and from 6% to 37%, respectively. A significant advantage in favor of RARP in comparison with RRP in terms of 12 months’ potency rates has been observed.

This chapter presents the technique for RARP described by Patel, which introduces some differences from the standard laparoscopic and robotic technique described previously.

Keywords

Erectile dysfunction Radical prostatectomy Bladder neck Pelvic lymph node dissection Radical retropubic prostatectomy Continence outcomes Potency outcomes Salvage RARP Oncological outcomes Radical prostatectomy complications 

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Copyright information

© Springer Nature Switzerland AG 2020

Authors and Affiliations

  • Bernardo Rocco
    • 1
  • Rafael Ferreira Coelho
    • 2
    • 3
  • Ahmed Eissa
    • 4
    • 5
  • Maria Chiara Sighinolfi
    • 1
  • Ahmed Elsherbiny
    • 4
    • 5
  • Ahmed Zoeir
    • 4
    • 5
  • Giovanni Pellacani
    • 5
    • 6
  • Vipul R. Patel
    • 7
    • 8
  1. 1.Department of UrologyOspedale Policlinico e Nuovo Ospedale Civile S. Agostino Estense Modena, University of Modena and Reggio EmiliaModenaItaly
  2. 2.Department of UrologyHospital Israelita Albert EinsteinSao PauloBrazil
  3. 3.Instituto do Câncer do Estado de São PauloSao PauloBrazil
  4. 4.Department of Urology, Faculty of MedicineTanta University HospitalTantaEgypt
  5. 5.Ospedale Policlinico e Nuovo Ospedale Civile S. Agostino Estense Modena, University of Modena and Reggio EmiliaModenaItaly
  6. 6.Department of DermatologyUniversity of Modena & Reggio EmiliaModenaItaly
  7. 7.Global Robotics Institute, Florida Hospital Celebration HealthCelebrationUSA
  8. 8.Department of UrologyUniversity of Central Florida School of MedicineOrlandoUSA

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