Improving Oncologic Outcomes After Robotic Radical Prostatectomy

  • Joseph A. SmithJr.


The oncologic efficacy of robotic assisted laparoscopic prostatectomy vs an open surgical approach is the key comparative outcome measure. Proponents of open surgery emphasize the importance of tactile feedback while robotic surgeons extoll the advantages of magnified visualization. With both approaches, the experience and skill of the surgeon are highly influential. Comparison of positive margin rates between different series is problematic because of differences in the manner of pathologic preparation and reporting. Evaluation of biochemical recurrence is more objective measure. Although some studies show superior results for one approach over another, the balance of studies show oncologic equivalence between different surgical approaches


Surgical techniques Radical prostatectomy Oncologic outcomes Learning curve Robotic surgery 


  1. 1.
    Farnham SB, Webster TM, Herrell SD, Smith JA Jr. Intraoperative blood loss and transfusion requirements for robotic-assisted radical prostatectomy versus radical retropubic prostatectomy. Urology. 2006;67:360-363.PubMedCrossRefGoogle Scholar
  2. 2.
    Webster TM, Herrell SD, Chang SS, et al. Robotic assisted laparoscopic radical prostatectomy versus retropubic radical prostatectomy: a prospective assessment of postoperative pain. J Urol. 2005;174:912-914.PubMedCrossRefGoogle Scholar
  3. 3.
    Krambeck AE, DiMarco DS, Rangel LJ, et al. Radical prostatectomy for prostatic adenocarcinoma: a matched comparison of open retropubic and robot-assisted techniques. BJU Int. 2009;103:448-452.PubMedCrossRefGoogle Scholar
  4. 4.
    Herrell SD, Smith JA Jr. Robotic-assisted laparoscopic prostatectomy: what is the learning curve? Urology. 2005;66:105-107.PubMedCrossRefGoogle Scholar
  5. 5.
    Patel VR, Tully AS, Holmes R, Lindsay J. Robotic radical prostatectomy in the community setting the learning curve and beyond: initial 200 cases. J Urol. 2005;174:269-272.PubMedCrossRefGoogle Scholar
  6. 6.
    Catalona WJ, Carvalhal GF, Mager DE, Smith DS. Potency, continence and complication rates in 1,870 consecutive radical retropubic prostatectomies. J Urol. 1999;162:433-438.PubMedCrossRefGoogle Scholar
  7. 7.
    Badani KK, Kaul S, Menon M. Evolution of robotic radical prostatectomy: assessment after 2766 procedures. Cancer. 2007;110:1951-1958.PubMedCrossRefGoogle Scholar
  8. 8.
    Patel VR, Palmer KJ, Coughlin G, Samavedi S. Robot-assisted laparoscopic radical prostatectomy: perioperative outcomes of 1500 cases. J Endourol. 2008;22:2299-2305.PubMedCrossRefGoogle Scholar
  9. 9.
    Jr Smith JA, Chan RC, Chang SS, et al. A comparison of the incidence and location of positive surgical margins in robotic assisted laparoscopic radical prostatectomy and open retropubic radical prostatectomy. J Urol. 2007;178:2385-2390.PubMedCrossRefGoogle Scholar
  10. 10.
    Costello AJ, Brooks M, Cole OJ. Anatomical studies of the neurovascular bundle and cavernosal nerves. BJU Int. 2004;94:1071-1976.PubMedCrossRefGoogle Scholar
  11. 11.
    Msezane LP, Reynolds WS, Gofrit ON, Shalhav AL, Zagaja GP, Zorn KC. Bladder neck contracture after robot-assisted laparoscopic radical prostatectomy: evaluation of incidence and risk factors and impact on urinary function. J Endourol. 2008;22:377-383.PubMedCrossRefGoogle Scholar
  12. 12.
    Ficarra V, Novara G, Artibani W, et al. Retropubic, laparoscopic, and robot-assisted radical prostatectomy: a systematic review and cumulative analysis of comparative studies. Eur Urol. 2009;55:1037-1063.PubMedCrossRefGoogle Scholar
  13. 13.
    Zorn KC, Gofrit ON, Orvieto MA, Mikhail AA, Zagaja GP, Shalhav AL. Robotic-assisted laparoscopic prostatectomy: functional and pathologic outcomes with interfascial nerve preservation. Eur Urol. 2007;51:755-763.PubMedCrossRefGoogle Scholar
  14. 14.
    Barocas DA, Salem S, Kordan Y, et al. Robot-assisted laparoscopic prostatectomy versus radical retropubic prostatectomy for clinically localized prostate cancer: comparison of short-term biochemical recurrence-free survival. J Urol. 2010;183(3):990-996.PubMedCrossRefGoogle Scholar
  15. 15.
    Hu JC, Wang Q, Pashos CL, Lipsitz SR, Keating NL. Utilization and outcomes of minimally invasive radical prostatectomy. J Clin Oncol. 2008;26:2278-2284.PubMedCrossRefGoogle Scholar
  16. 16.
    Hu JC, Gu X, Lipsitz SR, et al. Comparative effectiveness of minimally invasive vs open radical prostatectomy. JAMA. 2009;14:1557-1564.CrossRefGoogle Scholar

Copyright information

© Springer-Verlag London Limited 2011

Authors and Affiliations

  • Joseph A. SmithJr.
    • 1
  1. 1.Department of Urologic SurgeryVanderbilt University Medical CenterNashvilleUSA

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