Radical Prostatectomy: Respective Roles and Comparisons of Robotic and Open Surgeries
Article information
J Korean Med Assoc. 2010;53(2):119-125
Publication date (electronic) : 2010 February 28
doi :
https://doi.org/10.5124/jkma.2010.53.2.119
Abstract
Over the years, several surgical modifications have been incorporated into radical prostatectomy in order to improve the surgical outcome. Despite the rapid dissemination of robot-assisted laparoscopic prostatectomy (RALP) through the urologic community, comparative studies on the practicality of RALP compared to open radical prostatectomy (OP) are lacking. Thus, it remains difficult to draw any conclusions regarding cancer control and postoperative morbidity. This review will introduce the evolution of surgical technique and the current status of RALP in relation to OP in the management of localized prostate cancer focusing on the perioperative, oncological and functional outcomes. Based on the review of literatures, perioperative outcomes, such as blood loss, transfusion rates, hospitalization duration and complication rates, all favored RALP. The positive surgical margin rates of RALP were similar to those of OP with regard to the oncological outcomes. With regard to the functional outcomes, OP and RALP also showed similar continence and potency rates. However, refinements in technique employed during RALP have improved the early return of continence postoperatively. Although OP remains the gold standard treatment in localized prostate cancer, robotic surgery and continued technical advancements will ultimately improve patient outcomes. However, further prospective randomized comparative clinical trials with a long-term follow-up utilizing validated questionnaire are needed to prove the superiority of either surgical approach in terms of functional and oncological outcomes. In addition, RALP technique will need a substantial decrease in the cost of the robotic system to achieve wider global acceptance and application.
References
1. Rassweiler J, Sentker L, Seemann O, Hatzinger M, Rumpelt HJ. Laparoscopic radical prostatectomy with the Heilbronn technique: an analysis of the first 180 cases. J Urol 2001. 1662101–2108.
2. Rashid HH, Leung YY, Rashid MJ, Oleyourryk G, Valvo JR, Eichel L. Robotic surgical education: a systematic approach to training urology residents to perform robotic-assisted laparoscopic radical prostatectomy. Urology 2006. 6875–79.
3. Mavrich Villavicencio H, Esquena S, Palou Redorta J, Gómez Ruiz JJ. Robotic radical prostatectomy: overview of our learning curve. Actas Urol Esp 2007. 31587–592.
4. Lee YS, Han WK, Yang SC, Rha KH. Robot-assisted laparoscopic radical prostatectomy. Korean J Urol 2006. 47206–210.
5. Young HH. The early diagnosis and radical cure of carcinoma of the prostate: a study of 40 cases and presentation of a radical operation which was carried out in four cases. Johns Hopkins Hosp Bull 1905. 16315–321.
6. Walsh PC, Lepor H. The role of radical prostatectomy in the management of prostatic cancer. Cancer 1987. 60526–537.
7. Lepor H. Status of radical prostatectomy in 2009: is there medical evidence to justify the robotic approach? Rev Urol 2009. 1161–70.
8. Walsh PC, Donker PJ. Impotence following radical prostatectomy: insight into etiology and prevention. J Urol 1982. 128492–497.
9. Sved PD, Nieder AM, Manoharan M, Gomez P, Meinbach DS, Kim SS, Soloway MS. Evaluation of analgesic requirements and postoperative recovery after radical retropubic prostatectomy using long-acting spinal anesthesia. Urology 2005. 65509–512.
10. Slabaugh TK Jr, Marshall FF. A comparison of minimally invasive open and laparoscopic radical retropubic prostatectomy. J Urol 2004. 1722545–2548.
11. Schuessler WW, Schulam PG, Clayman RV, Kavoussi LR. Laparoscopic radical prostatectomy: initial short-term experience. Urology 1997. 50854–857.
12. Poulakis V, Dillenburg W, Moeckel M, de Vries R, Witzsch U, Zumbé J, Rassweiler J, Becht E. Laparoscopic radical prostatectomy: prospective evaluation of the learning curve. Eur Urol 2005. 47167–175.
13. Pasticier G, Rietbergen JB, Guillonneau B, Fromont G, Menon M, Vallancien G. Robotically assisted laparoscopic radical prostatectomy: feasibility study in men. Eur Urol 2001. 4070–74.
14. Rassweiler J, Frede T, Seemann O, Stock C, Sentker L. Telesurgical laparoscopic radical prostatectomy. Initial experience. Eur Urol 2001. 4075–83.
15. Ham WS, Park SY, Rha KH, Kim WT, Choi YD. Robotic radical prostatectomy for patients with locally advanced prostate cancer is feasible: results of a single-institution study. J Laparoendosc Adv Surg Tech A 2009. 19329–332.
16. Ham WS, Kim SW, Kim WT, Park SY, Choi YD. Robotic prostatectomy in patient with an abdominoperineal resection. J Laparoendosc Adv Surg Tech A 2009. 19383–387.
17. Capello SA, Boczko J, Patel HR, Joseph JV. Randomized comparison of extraperitoneal and transperitoneal access for robot-assisted radical prostatectomy. J Endourol 2007. 211199–1202.
18. Lee YS, Ham WS, Kim WT, Joo HJ, Lee JS, Choi YD. Comparison of Extraperitoneal and Transperitoneal Robot-Assisted Radical Prostatectomy in Prostate Cancer: A Single Surgeon s Experience. Korean J Urol 2009. 50251–255.
19. Krambeck AE, DiMarco DS, Rangel LJ, Bergstralh EJ, Myers RP, Blute ML, Gettman MT. Radical prostatectomy for prostatic adenocarcinoma: a matched comparison of open retropubic and robot-assisted techniques. BJU Int 2009. 103448–453.
20. Ahlering TE, Woo D, Eichel L, Lee DI, Edwards R, Skarecky DW. Robot-assisted versus open radical prostatectomy: a comparison of one surgeon's outcomes. Urology 2004. 63819–822.
21. Tewari A, Srivasatava A, Menon M. members of the VIP team. A prospective comparison of radical retropubic and robot-assisted prostatectomy: experience in one institution. BJU Int 2003. 92205–210.
22. Menon M, Tewari A, Baize B, Guillonneau B, Vallancien G. Prospective comparison of radical retropubic prostatectomy and robot-assisted anatomic prostatectomy: the Vattikuti Urology Institute experience. Urology 2002. 60864–868.
23. Ham WS, Park SY, Cho KS, Lee JS, Choi YD. Comparison of open and robotic Surgery in radical prostatectomy: A Single Surgeon's Experience. Korean J Urol 2008. 49221–226.
24. Gettman MT, Blute ML. Critical comparison of laparoscopic, robotic, and open radical prostatectomy: techniques, outcomes, and cost. Curr Urol Rep 2006. 7193–199.
25. Patel VR, Tully AS, Holmes R, Lindsay J. Robotic radical prostatectomy in the community setting the learning curve and beyond: initial 200 cases. J Urol 2005. 174269–272.
26. Drouin SJ, Vaessen C, Hupertan V, Comperat E, MisraÔ V, Haertig A, Bitker MO, Chartier-Kastler E, Richard F, RouprÍt M. Comparison of mid-term carcinologic control obtained after open, laparoscopic, and robot-assisted radical prostatectomy for localized prostate cancer. World J Urol 2009. 27599–605.
27. Penson DF, McLerran D, Feng Z, Li L, Albertsen PC, Gilliland FD, Hamilton A, Hoffman RM, Stephenson RA, Potosky AL, Stanford JL. 5-year urinary and sexual outcomes after radical prostatectomy: results from the prostate cancer outcomes study. J Urol 2005. 1731701–1705.
28. Hsu EI, Hong EK, Lepor H. Influence of body weight and prostate volume on intraoperative, perioperative, and postoperative outcomes after radical retropubic prostatectomy. Urology 2003. 61601–606.
29. Catalona WJ, Carvalhal GF, Mager DE, Smith DS. Potency, continence and complication rates in 1,870 consecutive radical retropubic prostatectomies. J Urol 1999. 162433–438.
30. Menon M, Tewari A. Vattikuti Institute Prostatectomy Team: Robotic radical prostatectomy and the Vattikuti Urology Institute technique: an interim analysis of results and technical points. Urology 2003. 6115–20.
31. Boccon-Gibod L. Radical prostatectomy: open? Laparoscopic? Robotic? Eur Urol 2006. 49598–599.
32. Rozet F, Jaffe J, Braud G, Harmon J, Cathelineau X, Barret E, Vallancien G. A direct comparison of robotic assisted versus pure laparoscopic radical prostatectomy: a single institution experience. J Urol 2007. 178478–482.
33. Zorn KC, Gofrit ON, Orvieto MA, Mikhail AA, Galocy RM, Shalhav AL, Zagaja GP. Da Vinci robot error and failure rates: single institution experience on a single three-arm robot unit of more than 700 consecutive robot-assisted laparoscopic radical prostatectomies. J Endourol 2007. 211341–1344.
34. Lavery HJ, Thaly R, Albala D, Ahlering T, Shalhav A, Lee D, Fagin R, Wiklund P, Dasgupta P, Costello AJ, Tewari A, Coughlin G, Patel VR. Robotic equipment malfunction during robotic prostatectomy: a multi-institutional study. J Endourol 2008. 222165–2168.
35. Kim WT, Ham WS, Jeong W, Song HJ, Rha KH, Choi YD. Failure and malfunction of da Vinci Surgical systems during various robotic surgeries: experience from six departments at a single institute. Urology 2009. 741234–1237.
Article information Continued
Copyright © 2010 Korean Medical Association
