Evidence-Based Comparison of Robotic and Open Radical Prostatectomy

Abstract

The rapid adoption of robotic-assisted laparoscopic radical prostatectomy (RALP) has occurred despite a lack of high-quality evidence demonstrating its oncologic advantages, safety, or cost effectiveness compared with open radical retropubic prostatectomy (ORP). This review examines the current literature comparing ORP and RALP, focusing on perioperative, oncologic, functional, and economic outcomes.

Description of the Open Anterograde Anatomic Radical Retropubic Prostatectomy Technique

“…The enhanced vision associated with a convenient sitting position, wider operative field, and ability for more precise movements are advantages of robotic-assisted surgery, and are part of evolution in surgical techniques toward better visualization of pelvic anatomical structures such as the cavernous nerve fibers within the periprostatic tissue, seminal vesicles, prostatic pedicle, apex, and urethra [1,2,5,[15][16][17][18]. This advancement has allowed for the development of a new method to perform an anterograde anatomical dissection technique that is more precise and less invasive than the classical open RRP described in 1983 by Walsh et al [2,5,6,[9][10][11]15,17,18]. Our study demonstrates the feasibility of performing this surgery using an open technique, without adding the high costs of new technology.…”

“…The operations were executed by second-year residents of our hospital's urology program, aided by one of the authors, who is a senior surgeon. All surgeries were performed as planned, without conversion to the Walsh technique, and had a similar duration to other RRP techniques [5,16]. Therefore, we believe that this surgical technique is both feasible and reproducible, since residents could complete it even in their first procedures supervised by a professor with an average surgical time of 145.5 minutes.…”

“…RARP has become the leading surgical technique in the United States, and its adoption is also expanding in other countries. Several systematic reviews and randomized controlled clinical trials have indicated that RARP and LRP are advantageous for the preservation of continence and recovery of potency, despite the absence of high-quality randomized controlled prospective trials supporting their superiority over open radical retropubic prostatectomy (RRP) and the significant disparity between video-assisted anterograde technique (laparoscopic or robotic) and the open retrograde Walsh RRP [2,5,6]. Furthermore, the high cost of robotic surgery has limited its use in developing countries such as Brazil, where the incidence of prostate cancer was estimated at 61,200 new cases in 2016, with an overall risk of 61.82 per 100,000 men [5,7].…”

“…Several systematic reviews and randomized controlled clinical trials have indicated that RARP and LRP are advantageous for the preservation of continence and recovery of potency, despite the absence of high-quality randomized controlled prospective trials supporting their superiority over open radical retropubic prostatectomy (RRP) and the significant disparity between video-assisted anterograde technique (laparoscopic or robotic) and the open retrograde Walsh RRP [2,5,6]. Furthermore, the high cost of robotic surgery has limited its use in developing countries such as Brazil, where the incidence of prostate cancer was estimated at 61,200 new cases in 2016, with an overall risk of 61.82 per 100,000 men [5,7]. We wished to investigate whether we could offer this new surgical technique to patients who do not have access to these expensive and complex technologies; thus, the aim of this study was to perform the same operation used in minimally invasive radical prostatectomy through an open retropubic incision without additional cost and with the same materials used in open retrograde prostatectomy.…”

Robotic Prostatectomy: Is it More Advantageous Regarding Quality of Life?

“…Günümüzde ABD'de prostat kanseri tedavisinde uygulanan cerrahi prosedürlerin %60'ından fazlasını artık robotik cerrahi oluşturmaktadır (2). Uzun dönem sonuçlar kısıtlı olmak üzere erken dönem sonuçlar değerlendirildiğinde RRP'nin onkolojik, cinsel fonksiyon ve üriner sistem semptomları bakımından ARP ile kıyaslanabilecek sonuçlara sahip olduğu görülmektedir (3,4,5). ARP ve RRP arasında kıyaslama yapan çalışmalarda kan kaybı, hastanede kalış süresi gibi parametrelerde RRP'nin tartışmasız şekilde bir avantaj sağladığı belirtilmektedir.…”