Robot-assisted Extraperitoneal Laparoscopic Radical Prostatectomy โ€“ A Review of the Current Literature

European Urological Review, 2010;5(1):15-8

Prostate cancer is the most commonly detected male cancer and the second leading cause of male cancer deaths in the US and Europe.1 Its prognosis is directly related to stage at diagnosis and treatment. With the widespread diffusion of screening for prostate cancer, the disease has been diagnosed more commonly in the organ-confined stage and in younger and healthier men.2

Conventional treatment options include radical prostatectomy (RP), external-beam radical radiotherapy, brachytherapy and active surveillance with or without regular biopsy.3 More recently, focal therapies such as cryoablation and high-intensity focused ultrasound have been introduced, but their oncological effectiveness remains uncertain. RP is an established and accepted treatment for localised and, more recently, locally advanced prostate cancer.

Overall 10-year prostate-specific androgen (PSA) progression rates after RP are around 30%.3 Recurrence rates are increased in men with a higher pre-operative PSA, Gleason grade or tumour stage and where there are positive margins in the pathological specimen.

In an effort to further decrease the morbidity of open RP, a minimally invasive surgical approach to treating prostate cancer was first described by Schuessler et al. in 1997.4 These authors performed the first successful laparoscopic RP (LRP). From their initial experience, the authors noted the challenging nature of LRP, with long operative times and hospital stays. Although cancer cure with LRP was deemed similar to that with RP, the authors concluded that LRP offered no significant advantage over RP. LRP was revived only in the late 1990s, as European surgeons re-evaluated it and reported feasibility with excellent operative outcomes.5โ€“8 However, the technical demands of the surgery and the important learning curve have prevented the widespread adoption of LRP by most urological surgeons. Specifically, the reduction in the range of motion, 2D vision, counterintuitive handโ€“eye co-ordination between real and visible movements and the reduced haptic sense are the main obstacles associated with a long learning curve.

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