Robotic Simple Prostatectomy: Technical Considerations and Outcomes

Abstract

The open approach has been the gold standard for simple prostatectomy, either through a retropubic enucleation with an anterior transverse prostatic capsulotomy (Millin) or through a suprapubic transvesical access. The simple laparoscopic prostatectomy may be an alternative to open simple prostatectomy with potentially lower morbidity, lower blood loss, faster recovery, shorter hospital stay, and earlier return to normal activities In 2002, Mariano et al.7 first described the technique for laparoscopic simple prostatectomy that was modified by several authors using both transperitoneal and extraperitoneal approaches. The American Urological Association (AUA) and European Association of Urology (EAU) guidelines suggest that open surgery should be the treatment for prostate volume higher than 80 g. Similarly to others procedures, some skilled urologists have replaced the open simple prostatectomy by the laparoscopic counterpart. Robotics brought contributions to laparoscopic simple prostatectomy allowing the enucleation of adenoma without the need for special devices due to the advantages provided by better visualization and robotic-articulated instruments. It also potentially facilitates hemostatic sutures to control the main prostatic vessels, resulting in reduced intraoperative blood loss. The closure of bladder and/or prostatic capsule is easier with robotic assistance. Robotic simple prostatectomy seems to have a shorter learning curve than pure laparoscopic, what would be a real alternative to a larger number of urologists to perform such a procedure with the minimally invasive approach. The drawbacks of robotic simple prostatectomy are the costs and the preferential transperitoneal approach. Although currently literature is scanty on this subject, multicentric studies with larger numbers of subjects are expected to compare the open, laparoscopic, and robotic simple prostatectomy.