Robot-Assisted Radical Prostatectomy

Abstract

Since the world’s first robot-assisted radical prostatectomy (RARP) was performed by Binder and Kramer in Germany about 10 years ago, there has been a rapid transition from this first pioneering operation to what has become the most common treatment modality for organ-confined prostate cancer in the USA, where approximately 80% of all prostatectomies are performed using robotic assistance (Binder and Kramer 2001; Su 2010). There is unequivocal evidence of lower bleeding rates for RARP (Tewari et al. 2003; Eden et al. 2002) but no good evidence of the overall superiority of one modality over another, and it is uncertain whether robotics can yet be justified, given the resulting increase in cost and training requirements (Dasgupta and Kirby 2009). The most important outcomes to assess when comparing open prostatectomy (ORP), and RARP, are cancer control, complications, urinary continence, and sexual potency. Unfortunately, progress in doing randomized controlled studies (RCTs) has been notoriously poor (Tewari et al. 2003) with only one such trial reported, comparing ORP and conventional laparoscopic technique (LRP) (Guazzoni et al. 2006). In addition, out of the thousands of papers published on the surgical treatment of prostate cancer with radical prostatectomy, there have been very few comparative studies. A recent review found 37 comparative studies: 23 ORP and LRP, 10 ORP and RARP, and four LRP and RARP (Ficarra et al. 2009).