Difficulties in Robotic Radical Prostatectomy

  • Manoj B. PatelEmail author
  • Sanket Chauhan
  • Kenneth J. Palmer
  • Vipul R. Patel


The task of learning robotic-assisted laparoscopic prostatectomy (RALP) can be quite challenging for both novice and experienced open or laparoscopic surgeons alike. Therefore, prior to the first procedure, adequate training and planning is required as the entire surgical team prepares for the upcoming challenge. The learning curve to achieve basic competency has been estimated to be between 20 and 25 cases. However, during the initial stage of the learning curve, the surgeon should screen potential operative candidates cautiously to minimize the technical challenges of the procedure by selecting “ideal candidates” so that the surgical team can ease into the experience. As the experience of the surgeon and robotic team develops, one can begin to entertain the idea of tackling more challenging clinical scenarios, as studies have shown that difficult cases were attempted after performing a median of 50 procedures.


  1. 1.
    Menon M, Shrivastava A, Tewari A, et al. Laparoscopic and robot assisted radical prostatectomy: establishment of a structured program and preliminary analysis of outcomes. J Urol. 2002;168(3):945-949.CrossRefPubMedGoogle Scholar
  2. 2.
    Perer E, Lee D, Ahlering T, Clayman R. Robotic revelation: laparoscopic radical prostatectomy by a nonlaparoscopic surgeon. J Am Coll Surg. 2003;10:1738-1741.Google Scholar
  3. 3.
    Lavery H, Palmer KJ, Coughlin G, Patel VR. The advanced learning curve in robotic prostatectomy: a multi-institutional survey. J Endourol. 2007;21(Suppl 1):8-61.Google Scholar
  4. 4.
    Venkatesh V, Landman J, Sundaram CP, et al. Prevention, recognition, and management of laparoscopic complications in urologic surgery. AUA Update Ser. 2003;12(40):322-331.Google Scholar
  5. 5.
    Litwiller JP, Wells RE Jr, Halliwill JR, et al. Effect of lithotomy positions on strain of the obturator and lateral femoral cutaneous nerves. Clin Anat. 2004;17:45-49.CrossRefPubMedGoogle Scholar
  6. 6.
    Tewari A, Rao SR. Anatomical foundations and surgical manoeuvres for precise identification of the prostatovesical junction during robotic radical prostatectomy. BJU Int. 2006;98:833-837.CrossRefPubMedGoogle Scholar
  7. 7.
    Mulhall JP, Slovick R, Hotaling J, et al. Erectile dysfunction after radical prostatectomy: hemodynamic profiles and their correlation with the recovery of erectile function. J Urol. 2002;167(3):1371-1375.CrossRefPubMedGoogle Scholar
  8. 8.
    Rogers CG, Trock BP, Walsh PC. Preservation of accessory pudendal arteries during radical retropubic prostatectomy: surgical technique and results. Urology. 2004;64(1):148-151.CrossRefPubMedGoogle Scholar
  9. 9.
    Matin SF. Recognition and preservation of accessory pudendal arteries during laparoscopic radical prostatectomy. Urology. 2006;67(5):1012-1015.CrossRefPubMedGoogle Scholar
  10. 10.
    Secin FP, Touijer K, Mulhall J, Guillonneau B. Anatomy and preservation of accessory pudendal arteries in laparoscopic radical prostatectomy. Eur Urol. 2007;51(5):1229-1235.CrossRefPubMedGoogle Scholar
  11. 11.
    Ahlering TE, Eichel L, Edwards RA, Lee DI, Skarecky DW. Robotic radical prostatectomy: a technique to reduce pT2 positive margins. Urology. 2004;64(6):1224-1228.CrossRefPubMedGoogle Scholar
  12. 12.
    Nguyen MM, Turna B, Santos BR, et al. The use of an endoscopic stapler vs suture ligature for dorsal vein control in laparoscopic prostatectomy: operative outcomes. BJU Int. 2008;101(4):463-466.PubMedGoogle Scholar
  13. 13.
    Campenni MA, Harmon JD, Ginsberg PC, Harkaway RC. Improved continence after radical retropubic prostatectomy using two pubo-urethral suspension stitches. Urol Int. 2002;68(2):109-112.CrossRefPubMedGoogle Scholar
  14. 14.
    Shalhav AL, Orvieto MA, Chien GW, Mikhail AA, Zagaja GP, Zorn KC. Minimizing knot tying during reconstructive laparoscopic urology. Urology. 2006;68(3):508-513.CrossRefPubMedGoogle Scholar
  15. 15.
    Anderson KR, Clayman RV. Laparoscopic lower urinary tract reconstruction. World J Urol. 2000;18:349-354.CrossRefPubMedGoogle Scholar

Copyright information

© Springer International Publishing AG 2018

Authors and Affiliations

  • Manoj B. Patel
    • 1
    Email author
  • Sanket Chauhan
    • 1
  • Kenneth J. Palmer
    • 1
  • Vipul R. Patel
    • 1
  1. 1.Department of Urologic SurgeryGlobal Robotics Institute, Florida Hospital-Celebration HealthCelebrationUSA

Personalised recommendations