J Korean Med Assoc Search


J Korean Med Assoc > Volume 55(7); 2012 > Article
Kim, You, and Jeong: Can robotic surgery be a standard procedure in the treatment of prostate cancer?


Despite the wide diffusion of robot-assisted laparoscopic radical prostatectomy (RALP) as a surgical approach for clinically localized prostate cancer, no randomized controlled trial has been performed to compare RALP to radical retropubic prostatectomy (RRP) or laparoscopic radical prostatectomy (LRP). Because it is difficult to perform a randomized controlled trial to determine the risks and benefits of RALP, we focused on the results of systematic reviews of the published literature to compare the perioperative complications, functional outcomes (continence and potency), and oncologic results (surgical margin status and biochemical recurrence) among RRP, LRP, and RALP. With regard to perioperative complications, RALP seemed to be superior to RRP and LRP. With regard to the functional results, RALP showed a tendency toward early continence and potency recovery, compared with RRP. With regard to the surgical margin status, RRP and RALP showed mixed results, but RALP tended to show favorable results in organ-confined disease. Experts have obtained good results whether they performed RRP or RALP. Consequently, experts have been continuing to debate this issue. The higher cost associated with RALP was another criticism, especially in Korea. Because most of the published studies had low quality of evidence and were underpowered to prove the superiority of any surgical approach, a special effort to standardize the research methodology is required. Further high-quality, prospective, comparative studies, integrating specialized research methodology may give us a vital clue about the value of RALP.


1. Park SK, Sakoda LC, Kang D, Chokkalingam AP, Lee E, Shin HR, Ahn YO, Shin MH, Lee CW, Lee DH, Blair A, Devesa SS, Hsing AW. Rising prostate cancer rates in South Korea. Prostate 2006;66:1285-1291.

2. Ministry of Health & Welfare. National Cancer Center. Cancer statistics in Korea 2009 [Internet] 2011;cited 2012 Jun 3. Goyang: National Cancer Information Center. Available from: http://www.cancer.go.kr/ncic/cics_g/cics_g02/cics_g027/1647906_6065.html

3. Cookson MM. Prostate cancer: screening and early detection. Cancer Control 2001;8:133-140.

4. European Association of Urology. Guidelines on prostate cancer [Internet] 2012;cited 2012 Jun 3. Arnhem: European Association of Urology. Available from: http://www.uroweb.org/gls/pdf/08%20Prostate%20Cancer_LR%20March%2013th%202012.pdf

5. Young H. Radical perineal prostatectomy. Johns Hopkins Hosp Bull 1905;16:315-321.

6. Memmelaar J. Total prostatovesiculectomy: retropubic approach. J Urol 1949;62:340-348.

7. Reiner WG, Walsh PC. An anatomical approach to the surgical management of the dorsal vein and Santorini's plexus during radical retropubic surgery. J Urol 1979;121:198-200.

8. Walsh PC, Donker PJ. Impotence following radical prostatectomy: insight into etiology and prevention. J Urol 1982;128:492-497.

9. Oelrich TM. The urethral sphincter muscle in the male. Am J Anat 1980;158:229-246.

10. Schuessler WW, Schulam PG, Clayman RV, Kavoussi LR. Laparoscopic radical prostatectomy: initial short-term experience. Urology 1997;50:854-857.

11. Guillonneau B, Vallancien G. Laparoscopic radical prostatectomy: the Montsouris experience. J Urol 2000;163:418-422.

12. Binder J, Kramer W. Robotically-assisted laparoscopic radical prostatectomy. BJU Int 2001;87:408-410.

13. Lowrance WT, Eastham JA, Savage C, Maschino AC, Laudone VP, Dechet CB, Stephenson RA, Scardino PT, Sandhu JS. Contemporary open and robotic radical prostatectomy practice patterns among urologists in the United States. J Urol 2012;187:2087-2092.

14. Centre for Evidence-Based Medicine. Levels of evidence (March 2009) [Internet] cited 2012 Jun 3. Oxford: Centre for Evidence-Based Medicine. Available from: http://www.cebm.net/index.aspx?o=1025

15. Patel VR, Sivaraman A, Coelho RF, Chauhan S, Palmer KJ, Orvieto MA, Camacho I, Coughlin G, Rocco B. Pentafecta: a new concept for reporting outcomes of robot-assisted laparoscopic radical prostatectomy. Eur Urol 2011;59:702-707.

16. Ficarra V, Novara G, Artibani W, Cestari A, Galfano A, Graefen M, Guazzoni G, Guillonneau B, Menon M, Montorsi F, Patel V, Rassweiler J, Van Poppel H. Retropubic, laparoscopic, and robot-assisted radical prostatectomy: a systematic review and cumulative analysis of comparative studies. Eur Urol 2009;55:1037-1063.

17. Tewari A, Sooriakumaran P, Bloch DA, Seshadri-Kreaden U, Hebert AE, Wiklund P. Positive surgical margin and perioperative complication rates of primary surgical treatments for prostate cancer: a systematic review and meta-analysis comparing retropubic, laparoscopic, and robotic prostatectomy. Eur Urol 2012;62:1-15.

18. Parsons JK, Bennett JL. Outcomes of retropubic, laparoscopic, and robotic-assisted prostatectomy. Urology 2008;72:412-416.

19. 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;92:205-210.

20. Joseph JV, Vicente I, Madeb R, Erturk E, Patel HR. Robot-assisted vs pure laparoscopic radical prostatectomy: are there any differences? BJU Int 2005;96:39-42.

21. Eastham JA. Robotic-assisted prostatectomy: is there truth in advertising? Eur Urol 2008;54:720-722.

22. Schroeck FR, Krupski TL, Sun L, Albala DM, Price MM, Polascik TJ, Robertson CN, Tewari AK, Moul JW. Satisfaction and regret after open retropubic or robot-assisted laparo-scopic radical prostatectomy. Eur Urol 2008;54:785-793.

23. Di Pierro GB, Baumeister P, Stucki P, Beatrice J, Danuser H, Mattei A. A prospective trial comparing consecutive series of open retropubic and robot-assisted laparoscopic radical prostatectomy in a centre with a limited caseload. Eur Urol 2011;59:1-6.

24. Menon M. Robot-assisted radical prostatectomy: is the dust settling? Eur Urol 2011;59:7-9.

25. Bolenz C, Gupta A, Hotze T, Ho R, Cadeddu JA, Roehrborn CG, Lotan Y. Cost comparison of robotic, laparoscopic, and open radical prostatectomy for prostate cancer. Eur Urol 2010;57:453-458.

26. Tomaszewski JJ, Matchett JC, Davies BJ, Jackman SV, Hrebinko RL, Nelson JB. Comparative hospital cost-analysis of open and robotic-assisted radical prostatectomy. Urology 2012;05. 16. [Epub]. DOI: 10.1016/j.urology.2012.03.020.

27. Lee HW, Lee HM, Seo SI. Comparison of initial surgical outcomes between laparoscopic radical prostatectomy and robot-assisted laparoscopic radical prostatectomy performed by a single surgeon. Korean J Urol 2009;50:468-474.

28. Current Controlled Trials Ltd. Randomised controlled trial of laparoscopic, open and robot assisted prostatectomy as treatment for organ-confined prostate cancer (LopeRA) [Internet] cited 2012 Jun 3. London: Current Controlled Trials Ltd. Available from: http://www.controlled-trials.com/ISRCTN59410552

Table 1
Reported studies of a systematic review and meta-analysis comparing retropubic, laparoscopic, and robot-assisted laparoscopic radical prostatectomy.

RRP, radical retropubic prostatectomy; LRP, laparoscopic radical prostatectomy; RALP, robot-assisted laparoscopic radical prostatectomy.

Table 2
Comparison of the cost for the three types of radical prostatectomies

RRP, radical retropubic prostatectomy; LRP, laparoscopic radical prostatectomy; RALP, robot-assisted laparoscopic radical prostatectomy.


Browse all articles >

Editorial Office
37 Ichon-ro 46-gil, Yongsan-gu, Seoul
Tel: +82-2-6350-6562    Fax: +82-2-792-5208    E-mail: jkmamaster@gmail.com                

Copyright © 2024 by Korean Medical Association.

Developed in M2PI

Close layer
prev next