Robotic-assisted laparoscopic prostatectomy

Abstract

Prostate cancer remains a significant health problem worldwide and is the second highest cause of cancer-related death in men. While there is uncertainty over which men will benefit from radical treatment, considerable efforts are being made to reduce treatment related side-effects and in optimising outcomes. This article reviews the development and introduction of robotic-assisted laparoscopic radical prostatectomy (RALP), the results to date, and the possible future directions of RALP. Prostate cancer remains a significant health problem worldwide and is the most common cancer affecting men in the United Kingdom, with over 34 000 cases diagnosed in 2005. It is the second leading cause of cancer-related death among men in the UK and the lifetime risk of being diagnosed with prostate cancer is around one in ten. In contrast, in the United States, it is the third commonest cause of cancer-related death among men and the lifetime risk of being diagnosed is one in six, which largely is the consequence of higher rates of PSA testing and screening.Conventional treatment options include radical prostatectomy (RP), external beam radical radiotherapy, brachytherapy and active monitoring or surveillance with or without regular biopsy. More recently, focal therapies such as cryoablation and highintensity focused ultrasound have been introduced, but their oncological effectiveness remains uncertain. Radical prostatectomy is an established and accepted treatment for localised and more recently, for locally advanced prostate cancer. Overall 10-year PSA progression rates after RP are around 30%. Recurrence rates are increased in men with a higher pre-operative PSA, Gleason grade, or tumour stage and if there are positive margins in the pathological specimen.Surgery can be performed by traditional open surgery, or laparoscopically -with or without robotic assistance. This article reviews the development and introduction of robotic-assisted laparoscopic RP (RALP), the results to date, and the possible future directions. In order to concentrate on outcomes when the learning curve has been passed, we have for the purposes of this review included studies where 500 or more cases of RALP have been reported plus other selected references. HISTORY OF RADICAL PROSTATECTOMYThe first perineal prostatectomy was performed by Proust in France in 1901, followed by Young in 1905 in the United States of America who performed the surgery on men with prostate cancer. During the early years, there was significant mortality and morbidity, with some surgeons reporting up to 30% mortality rates. Improvements in technique were made, and Millin's retropubic prostatectomy was used for patients with prostate cancer by Memmelaar and others from the late 1940's. It was not until 1983 that the operation was refined by Walsh who also reported the use of a nerve-sparing procedure to improve postprostatectomy potency rates. The first laparoscopic RP was performed in 1991 by Schuessler and, as with open surgery, advances have been made to improve outcomes, inc...

Haemodynamics and cardiac function during robotic‐assisted laparoscopic prostatectomy in steep Trendelenburg position

“…For 2010, it was expected that almost 80% of all radical prostatectomies would be done using robotic-assisted techniques, rendering the robotic approach the predominant treatment type for prostate cancer. In Europe, a similar development was expected, with a delay of a few years (4).…”

Men's experiences of regaining urinary continence following robotic‐assisted laparoscopic prostatectomy (RALP) for localised prostate cancer: a qualitative phenomenological study

“…Despite the lack of randomised controlled trials demonstrating the superiority of RALP over open and laparoscopic techniques, RALP has become the procedure of choice in several national and international centres (Klotz , Menon & Bhandhari , Sharma et al . , Montorsi et al . ).…”

“…Despite the lack of randomised controlled trials demonstrating the superiority of RALP over open and laparoscopic techniques, RALP has become the procedure of choice in several national and international centres (Klotz 2007, Menon & Bhandhari 2008, Sharma et al 2009, Montorsi et al 2012. Published results regarding continence from large single-centre studies appear promising with 89-95% of men regaining complete urinary control within three months post-RALP (Menon et al 2007, Patel et al 2007, Murphy et al 2009).…”

Unilateral positive biopsies in low risk prostate cancer patients diagnosed with extended transrectal ultrasound‐guided biopsy schemes do not predict unilateral prostate cancer at radical prostatectomy

“…In addition, the side effects of whole gland treatments are frequent, i.e. urinary incontinence (5–20%), erectile dysfunction (30–60%) and bowel toxicity (5–10%) [6–8]. Thus, prostate cancer stage migration has led many urologists to different therapeutic options in order to reduce morbidity while maintaining oncological efficacy.…”