Robotically Assisted Laparoscopic Radical Prostatectomy: A Brief Review of Outcomes

Over 75,000 radical prostatectomies were performed in the USA last year for the treatment of prostate cancer. Most of these were performed by radical retropubic prostatectomy (RRP), the gold standard for treatment of this disease. However, the quest for increased efficacy and decreased morbidity is having as profound an impact on the treatment of prostate cancer as in any other area of medicine. There are two unique factors at work in the search for decreased morbidity in prostate cancer treatment. The first is the high prevalence, since prostate cancer is diagnosed in 1 in 6 men during their lifetime. The second involves the well-known side effects of incontinence and erectile dysfunction, whose impact is often more crippling psychologically than physically. The original minimally invasive treatment for prostate cancer, interstitial brachytherapy, has now been joined by novel technologies such as high-intensity focused ultrasound, cryotherapy, and, most recently, by another form of radiation delivery, Cyberknife. These technologies will likely all find a place in our armamentarium, but even the most seasoned of these treatments (brachytherapy) still has limitations that prevent it from replacing surgical removal of the prostate. For these reasons, both patients and urologic surgeons have continued to seek out less invasive surgical options. In 1991, Clayman et al performed the first laparoscopic radical prostatectomy (1). In the USA, enthusiasm over this procedure was mitigated by prolonged operative times, a steep learning curve, and a failure to demonstrate major advantages over open surgery. In Europe, however, the experience continued, and investigators began to present laparoscopic prostatectomy outcomes that were comparable to those of open surgery with roughly equivalent operative times (2, 3). However, the procedure never gained widespread acceptance, likely due to the technical challenges of traditional laparoscopic instrumentation. In 2001, the Henry Ford Hospital described the first robotic prostatectomy (4), and shortly thereafter surgeons there published short-term outcome data comparing RRP with robotically assisted laparoscopic radical prostatectomy (RALP) (5, 6). Since that time the urology community has seen unparalleled growth in this procedure. Roughly 8500 RALP procedures were performed in 2004 and 18,000 in 2005; it has been estimated that 35% of all prostatectomies performed in 2007 will be performed robotically.