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Outcomes of RALP: An Evidence-Based Approach

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Robotic Urologic Surgery

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Abstract

Prostate cancer (PCa) is the third most common malignancy (7.3%) following breast (11.7%) and lung cancers (11.4%), and the eighth most common cause of cancer mortality (3.8%) in 2020. Furthermore, it is the most frequently diagnosed male cancer in 112 countries around the globe [1]. PCa represents a major health burden as it was responsible for 7.1 million disability-adjusted life-years (of which, 88% are years of life lost and 12% are years of life with disability) around the world in 2017 [2]. Radical prostatectomy (RP) is considered the mainstay of surgical treatment for men with localized PCa and life expectancy >10 years [3]. The first description of RP for treatment of PCa dates back to the early 1900s, when Young H [4], reported his experience with open perineal prostatectomy in 75 patients; however, this approach was associated with high morbidity and mortality as it was used in the era before the introduction of antibiotics, balloon catheters and blood transfusion in the medical practice. After approximately 40 years, Millin [5] modified the RP approach to be performed through an abdominal incision, yet it was still associated with severe blood loss from the dorsal venous complex (DVC) as it was not tied [6]. Later on, Walsh introduced several modifications to the retropubic RP technique including the ligation of the DVC and the nerve-sparing RP, which reduced the perioperative complications of this surgery and improved its outcomes [6]. As laparoscopic approaches became popular among surgeons, Raboy et al. [7], reported the first case of laparoscopic radical prostatectomy (LRP), which seemed to be associated with several advantages over the ORP, including less intraoperative blood loss and postoperative pain, and shorter hospitalization [8]; however, the laparoscopic approach was not devoid of drawbacks such as the longer operative time and learning curve, and the two-dimensional vision compared to the open approach [6]. In the early 2000s, robotic surgery was introduced and popularized because of its important advantages including three-dimensional (3D) vision, articulated instruments with seven degrees of freedom, magnified vision, tremors filtration, and shorter learning curve [8]. In this setting, the robotic approach to RP was first introduced in 2001 [9], and since then it gained great acceptance among surgeons and patients; as a consequence, to date, approximately 85% of RPs are performed through robotic-assisted laparoscopic approach in the USA [10, 11].

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Authors and Affiliations

  1. Urology Department, ASST Santi Paolo e Carlo, University of Milan, Milan, Italy

    Maria Chiara Sighinolfi

  2. Department of Urology and Division of Experimental Oncology, Urological Research Institute (URI), IRCCS San Raffaele Scientific Institute, Milan, Italy

    Francesco Montorsi

  3. Urology Department, Faculty of Medicine, Tanta University, Tanta, Egypt

    Ahmed Eissa

  4. Global Robotics Institute, Florida Hospital-Celebration Health Celebration, University of Central Florida School of Medicine, Orlando, FL, USA

    Vipul Patel

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  1. Maria Chiara Sighinolfi
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  2. Francesco Montorsi
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  3. Ahmed Eissa
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  4. Vipul Patel
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  1. Department of Urology, Icahn School of Medicine at Mount Sinai, New York, USA

    Peter Wiklund

  2. Department of Urology, ORSI Academy, Aalst, Belgium

    Alexandre Mottrie

  3. Pediatric Urology, University of Chicago Medicine and Biological Sciences, Chicago, IL, USA

    Mohan S Gundeti

  4. Urology, Global Robotics Institute, Celebration, FL, USA

    Vipul Patel

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Sighinolfi, M.C., Montorsi, F., Eissa, A., Patel, V. (2022). Outcomes of RALP: An Evidence-Based Approach. In: Wiklund, P., Mottrie, A., Gundeti, M.S., Patel, V. (eds) Robotic Urologic Surgery. Springer, Cham. https://doi.org/10.1007/978-3-031-00363-9_19

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