Recent Advances in Robot-Assisted Laparoscopic Prostatectomy

Abstract

Introduction: Ever since the first RALP was performed in May 2000, the robotic approach has surpassed the expectations with >80% of prostatectomies in the United States being performed using the robot. Other than technical advances taking place with the robotic machine and the robotic instruments, there have been massive strides in the improvement of the technique. Better understanding of the anatomy of the neurovascular bundles and also the improvements in the imaging technology has impacted on the way the procedure is performed. This review looks into the developments that have taken place over the last three years. Materials and methods: Articles pertaining to robot assisted laparoscopic prostatectomy published over the last three years were extracted from PUBMED and analysed. Those articles that have impacted on the clinical practice were reviewed. Results: Recently, the concept of incremental nerve sparing techniques has emerged. Two leading authorities have classified the degree of nerve sparing based on visual cues and have demonstrated its impact on functional and oncological outcomes. Another technical modification to the procedure has been in inserting a supra-pubic catheter. This has been shown to improve the quality of life of patients by avoiding a per-urethral catheter without any negative impact on continence or increased risk of bladder neck contracture. Previously, nerve sparing was correlated with erectile function. However, recent studies have highlighted that nerve preservation has also an impact on the continence rates. Randomized control trials have now demonstrated the superiority of barbed sutures over the conventional monofilament sutures. Image guided surgery is making its way into RALP and more research in this field will aid in better oncological control with minimal sacrifice of important structures around the prostate. Conclusion: Advances in surgical techniques are resulting in better functional and oncological outcomes. This has a direct impact in improving the quality of life for the patients. More research into application of emerging technology such as integration of image-guided surgery will herald better outcomes in the near future.

Guideline Implementation: Minimally Invasive Surgery, Part 1

“…Having dedicated circuits decreases the possibility of circuit overload and system malfunction. 3 Cables connecting the robotic system should be placed so they are neither in the path of OR traffic nor interfering with movement of the patient cart from its preoperative draping area to the patient operative site. This placement also protects the cables from damage.…”

“…In the early 2000s, robotic surgery added another layer of complexity to the already technical minimally invasive OR. 2,3 All these factors added to a demanding perioperative environment that requires new knowledge, increased cooperation, and different skill mixes to achieve optimal patient outcomes. 4 The AORN "Guideline for minimally invasive surgery" 4 was updated in December of 2016.…”