Has robotic prostatectomy determined the fall of the laparoscopic approach?

John Hayes,Prokar Dasgupta,Nikhil Vasdev

doi:10.20517/2574-1225.2021.126

Abstract

Robotic-assisted laparoscopic prostatectomy (RALP) has revolutionised the surgical management of localised prostate cancer in the modern era. The surgeon is provided with greater precision, more versatile dexterity and an immersive three-dimensional visual field. The impressive hardware facilitates, for example, the dissection of the peri-prostatic fascia, whilst preserving the neurovascular bundle, or the suturing of the vesico-urethral anastomosis. Prior to RALP, laparoscopic radical prostatectomy (LRP) represented the first venture into the minimally invasive world. Associated with more cumbersome ergonomics, LRP has a significant learning curve compared with the robotic approach. There has been a paucity, until recently, of high-quality literature comparing outcomes between the two operations, including the attainment of the Pentafecta of survivorship: biochemical recurrence-free, continence, potency, no postoperative complications and negative surgical margins.

Highlights

Today, the majority of men with intermediate or high-risk localised prostate cancer, who are candidates for surgical intervention, will undergo a robotic-assisted laparoscopic prostatectomy (RALP)
Comprising a surgeon console, patient cart and vision cart, the surgeon is provided with improved ergonomics, more versatile dexterity, beyond that of the human wrist, and enhanced three-dimensional high-definition optics
Ashutosh Tewari offers a helpful analogy whilst arguing the case for the robotic approach, with its improved visuals, in the Wall Street Journal (2018): “When Swiss watchmakers start working in the dark, relying on tactile feedback and not magnifying glasses, we’ll believe that surgery should be done by touch and not by direct visualisation of the anatomical structures”

Summary

Introduction

The majority of men with intermediate or high-risk localised prostate cancer, who are candidates for surgical intervention, will undergo a robotic-assisted laparoscopic prostatectomy (RALP). Prior to the current era of minimally invasive surgery, the standard approach was open radical prostatectomy. The postoperative morbidity associated with the procedure led surgeons to explore less invasive approaches.

Results

Conclusion