Outcomes of robotic assisted radical prostatectomy

Abstract

Robot-assisted radical prostatectomy (RARP) is a rapidly evolving technique for the treatment of localized prostate cancer. However, cynics point to the increasing role of market forces in the robotic revolution. As yet, Europe has not taken up RARP in large numbers and this may in part relate to the high level of expertise in laparoscopy previously gained. Furthermore, setting up a robotic program is a major undertaking for many surgical units. This article reviews the current literature on RARP with regard to oncologic, continence and potency outcomes -the so called 'trifecta'. Preliminary data appears to show an advantage of RARP over open prostatectomy with reduced blood loss, decreased pain, early mobilization, shorter hospital stay and lower margin rates. Most intra-institutional studies demonstrate good postoperative continence and potency with RARP; however this needs to be viewed in the context of a paucity of randomized data available in the literature. There is no definitive data to show an advantage over standard laparoscopy, but the fact that this technique has reached parity with laparoscopy within 5 years is encouraging.

Zygomatic Bone-to-Implant Contact in 77 Patients With Partially or Completely Edentulous Maxillas

“…7,8 Recent surgical techniques have been adopted to shorten recovery time, decrease the cost of treatment, and drastically lessen surgical and recovery complications in all fields of medicine. 7,[9][10][11][12][13][14][15] One such technique involves the placement of implants in the zygomatic bone. Zygomatic implants provide craniofacial anchorage and allow for immediate prosthetic loading.…”

Hemidiaphragm Paralysis after Robotic Prostatectomy: Medical Malpractice or Unforeseeable Event?

“…Since the subject did not present other diseases that could be attributed to the diaphragm paralysis, we focused on literature data to support the possibility of the occurrence of diaphragmatic paralysis after RARP. This research has yielded a negative result; many other reasons are known complications associated with this procedure [7][8][9] . The literature reports cases of diaphragmatic injuries related to laparoscopic urological surgery conducted on nearby structures such as the diaphragm, kidneys, lymph nodes, and adrenal glands [10] .…”

Does the presence of robotic surgery affect demographics in patients choosing to undergo radical prostatectomy? A multi-center contemporary analysis

“…Published data on RARP shows an advantage over open surgery with respect to reduced blood loss, decreased pain, and early mobilization resulting in shorter hospital stay [10]. With improved vision, magnification, and dexterity of the robotic platform, the potential for improved quality of life outcomes of continence and potency has been postulated [11, 12. Whether RARP is able to demonstrate better functional outcomes with better postoperative continence and potency remains controversial [13], because of a paucity of randomized data available in the literature. However, most intra-institutional comparisons appear to show a benefit with robotic surgery [14].…”

“…RARP is now generally accepted by urologists as the ''gold standard'' of curative treatment for prostate cancer in the United States, where over 60% of radical prostatectomies are performed robotically [13]. In stark contrast to the US, there are currently only 15 robotic systems in the UK, where less than 5% of radical prostatectomies are performed robotically.…”