Open versus Laparoscopic Radical Prostatectomy

Abstract

Radical prostatectomy (RP) is a curative treatment for localized prostate cancer that involves removing the prostate and seminal vesicles. The primary goals of RP include ensuring oncologic control and maintaining the preoperative status of continence and potency. This report focuses on the outcomes and the keys to success for both open retropubic and laparoscopic RP. Both surgical volume and the surgeon are directly related to postoperative erectile function in men. The preoperative status of the patients is also of importance because it significantly affects postoperative functional outcomes. Surgical steps, which are keys to success following the open procedure, include incision of the endopelvic fascia, control of the Santorini plexus, and nerve-sparing procedures. Similarly, the key surgical steps of laparoscopic prostatectomy are described and a comparison between the transperitoneal and extraperitoneal route is made. Oncologic and functional outcomes observed following the two procedures are discussed. This report then briefly introduces the robotic surgical system and summarizes the related panel discussion. In conclusion, the difference between one surgeon's performance and that of another seems to count for more than any difference between procedures. Whilst postoperative functional outcomes are hard to evaluate, they seem to be comparable following the two different approaches.