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Can robotic surgery be a standard procedure in the treatment of prostate cancer?

Article information

J Korean Med Assoc. 2012;55(7):629-634
Publication date (electronic) : 2012 July 11
doi : https://doi.org/10.5124/jkma.2012.55.7.629
Choung-Soo Kim, MD, Dalsan You, MD, In Gab Jeong, MD
Department of Urology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
Corresponding author: Choung-Soo Kim, cskim@amc.seoul.kr
Received 2012 June 15; Accepted 2012 June 25.

Abstract

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.

Keywords: Prostatic neoplasms; Radical prostatectomy; Robotics; Evidence-based medicine

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Copyright © 2012 Korean Medical Association

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Table 1

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

Table 1

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

Table 2

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