Laparoscopic and robotic radical prostatectomy

Abstract

Radical retropubic prostatectomy is the current gold standard for surgical removal of the prostate gland. Recently, laparoscopic radical prostatectomy has been developed in an attempt to decrease surgical morbidity, and the technical difficulty of laparoscopy has been countered with the development of the da Vinci robotic interface. Studies that have compared the minimally invasive approaches with the traditional open approach have reported comparable perioperative outcomes. While long-term oncological data are available for open prostatectomy, there are only short-term studies available for laparoscopic prostatectomy. Functional outcomes, including urinary continence and sexual function, appear to be similar between the surgical approaches in the short term. However, currently, costs appear to favor open surgery, with the da Vinci-assisted prostatectomy having the highest expenses. Longer-term data are required to confidently determine the optimal balance between morbidity, oncological efficacy, functional outcomes and cost among the differing surgical approaches.

A retrospective comparison of anesthetic management of robot-assisted laparoscopic radical prostatectomy versus radical retropubic prostatectomy

“…Although some groups claim that RALP improves patient outcomes, there is still no consensus as to which technique of radical prostatectomy provides improved long-term outcomes over another [9,11,34]. Likewise, in our study, the number of PSA recurrences and the time to PSA recurrence were similar between the two procedures.…”

The normal post-surgical anatomy of the male pelvis following radical prostatectomy as assessed by magnetic resonance imaging

“…e The puboprostatic ligaments are divided several millimetres anterior to the anterior aspect of the prostate approach, and the need for less technical laparoscopic expertise permits a short learning curve of approximately 8-12 cases to transfer open surgery skills to this setting [25]. In experienced hands, the outcome of this procedure appears to be very favourable with minimal blood loss and operative morbidity, excellent functional results and oncological efficacy at 5 years equivalent to conventional laparoscopic and open procedures [26]. However, longterm data are not yet available for either of these minimally invasive approaches.…”

Label-Free Molecular Vibrational Imaging for Cancer Diagnosis

“…In this surgical procedure, the entire prostate is removed and the bladder is reconnected to the urethra [16]. The three main domains assessed to determine radical prostatectomy efficacy are cancer control and post-operative urinary and erectile function [17]. While there are distinct factors that may contribute to each, all are dependent, to a large degree, on precise surgical techniques [18].…”