Introduction: To review the current status of laparoscopic radical prostatectomy (LRP) and robotic assisted radical prostatectomy (RALP) in relation to radical retropubic prostatectomy (RRP) in the management of localized prostate cancer. Materials and Methods: Between 1982 and 2007 published literature was reviewed using the National Library of Medicine database and the following key words: retropubic, laparoscopic, robotic, robot-assisted, and radical prostatectomy. Special emphasis was given to the technical and cost considerations as well as operative, functional and oncologic outcomes. In particular, reports with pioneering work that have contributed to the evolution of the technique, presenting comparative outcomes and with large series encompassing intermediate/long term follow-up, were taken into account. Results: After intermediate term follow-up, LRP and RALP achieved similar oncologic and functional results compared to RRP. However, LRP and RALP were associated with decreased blood loss, faster convalescence and better cosmetics when compared to RRP. The RALP technique is undoubtedly more expensive. Conclusions: The oncologic and functional outcomes for LRP and RALP are similar to RRP after intermediate term follow-up. Long term follow-up and adequately designed studies will determine the inherent advantages and disadvantages of the individual techniques in the management of localized prostate cancer.

Prolonged warm ischemia, increased intraoperative blood loss and solitary kidney status increase the likelihood of postoperative complications after laparoscopic partial nephrectomy. With experience the incidence of complications has decreased significantly despite a significant increase in tumor and procedural complexity.

Laparoscopic partial nephrectomy and probe ablative procedures can be safely and efficiently done for renal tumor in patients with a solitary kidney. Intermediate term oncological outcomes are superior for laparoscopic partial nephrectomy despite somewhat poorer renal function outcomes than those of cryoablation and radio frequency ablation.

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Purpose: Patients with muscle-invasive bladder cancer and concomitant upper urinary tract tumors may be candidates for simultaneous cystectomy and nephroureterectomy. Other clinical conditions such as dialysis-dependent end-stage renal disease and non-functioning kidney are also indications for simultaneous removal of the bladder and kidney. In the present study, we report our laparoscopic experience with simultaneous laparoscopic radical cystectomy (LRC) and nephroureterectomy. Materials and Methods: Between August 2000 and June 2007, 8 patients underwent simultaneous laparoscopic radical nephroureterectomy (LNU) (unilateral-6, bilateral-2) and radical cystectomy at our institution. Demographic data, pathologic features, surgical technique and outcomes were retrospectively analyzed. Results: The laparoscopic approach was technically successful in all 8 cases (7 males and 1 female) without the need for open conversion. Median total operative time, including LNU, LRC, pelvic lymphadenectomy and urinary diversion, was 9 hours (range 8-12). Median estimated blood loss and hospital stay were 755 mL (range 300-2000) and 7.5 days (range 4-90), respectively. There were no intraoperative complications but only 1 major and 2 minor postoperative complications.(range 1-45). Conclusions: Laparoscopic nephroureterectomy with concomitant cystectomy is technically feasible. Greater number of

subgroups were comparable in age, body mass index, preoperative prostate-specific antigen level, preoperative Gleason score, clinical stage, operative duration, length of hospital stay, duration of catheterization, biochemical recurrence and continence after LRP. In the patients with a prostate of ≤ 30 g there was a higher incidence of positive margins (39% vs 16% vs 27%; P = 0.03) and inferior 1-year potency (47% vs 75% vs 79%; P = 0.04), respectively. Estimated blood loss increased with increasing prostate size (204 vs 256 vs 340 mL; P = 0.01). CONCLUSIONSProstate size has no effect on continence or biochemical recurrence at 1 year after LRP, but affects intraoperative blood loss, potency and surgical margins. More patients with a longer follow-up are needed to confirm these findings.

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