Use Of Small Incisions Research Articles

Pay attention to the prevention and treatment of deep sternal wound infection after sternotomy

Deep sternal wound infection (DSWI) is one of the potential and catastrophic complications after cardiac surgery. Despite the use of smaller incisions, routine application of prophylactic antibiotic and optimized blood glucose management, the incidence rate of DSWI still fluctuates between 1% and 5%. The early symptoms and signs of DSWI are not often obvious, making it too late for the clinicians to intervene in the process. Once left untreated, DSWI carries a very high mortality rate. Therefore, early prevention, diagnosis, and appropriate management of DSWI are crucial in preventing its progression to life-threatening outcomes. Considering the clinical severity and treatment complexity of DSWI, this article focuses on preventive experiences in each stage of DSWI, and reconstructive strategies after DSWI happens, raising attention among the medical community regarding DSWI.

History of endoscopic and keyhole spinal surgery

Development of endoscopic and keyhole surgery is often considered among the greatest scientific advancements in medicine alongside other scientific breakthroughs such as the discovery of antibiotics and the deciphering of DNA structure. The earliest concept of laparoscopy or endoscopy dates back to the use of instruments to visualize various body orifices as recorded in the notes of Hippocrates dating between 460 and 375 B.C. Adequate exposure of the surgical field which is key to safe surgical procedures required large incisions to identify the anatomical structures in the traditional open surgical approaches, and in an attempt to reduce the iatrogenic tissue trauma, smaller corridors were developed to utilize the technological advancements in magnification and illumination, and more recently navigation. As expected, perioperative morbidity is directly proportional to the extent of tissue trauma and surgical dissection, and the shift toward minimizing tissue dissection and prolonged retraction has been generally associated with earlier mobilization, reduced bleeding, and generally reduced morbidity in comparison to traditional open techniques. The advances in surgical technology, particularly in the light source and smaller cameras allowed the use of smaller incisions and adoption of minimal access surgery in the various surgical disciplines, laparoscopic cholecystectomy evolved as a cultural changing procedure and highlighted the focus on minimizing the surgical morbidity experienced by the patient. In spinal surgery, the evolution of surgical loupes, operating microscope, fiber optic light source, and minimal access surgical tools and retractors, allowed for improved surgical field visualization, resulting in smaller incisions and approaches. The initial adoption started with Lumbar discectomy and spinal stenosis decompression and evolved in other aspects of percutaneous fixation and minimal access fusion techniques applicable to trauma, degenerative disease, and tumors. This brief outline of the development of endoscopic and microscopic keyhole techniques in spinal surgery attempts to touch upon the major developments that paved the way for the large plethora of keyhole spinal surgical techniques currently available from the authors’ perspective.

Videoscope-assisted minimally invasive periodontal surgery for bone regeneration (VMIS)

Following the introduction of minimally invasive surgical techniques for treating periodontal defects, a novel visualization method was essential to allow for the use of smaller incisions and for a lingual access surgical approach. A videoscope has been developed for use in minimally invasive periodontal surgery that facilitates visualization of the periodontal defect and permits access to the defect from the lingual aspect. The minimally invasive surgical technique developed to utilize the benefits of the videoscope is known as videoscope-assisted minimally invasive surgery (VMIS). This article reviews the technique for performing the VMIS procedure for periodontal lesions on natural teeth and for peri-implant lesions on implants.

Small Incision in Lower Posterior Axillary Wall Combining Multihole Drainage Technique for the Treatment of Axillary Bromhidrosis

Surgical excision of apocrine glands is an effective method for the treatment of bromhidrosis. However, common postoperative complications such as skin necrosis can result in prolonged healing and unsightly scars, which are mainly caused by surgical injuries and seroma or hematoma formation. We have improved the traditional surgical methods, in the hope that the new method can not only ensure the surgical effect, but also minimize the surgical trauma and postoperative complications. Forty-four patients with bromhidrosis were included. A 1-cm incision was made in the posterior wall of the lower axilla. Tissue scissors completely separated the skin from the subcutaneous tissue of glandular distribution. Iris scissors were used to trim subcutaneous glandular tissue, until there was only full-thickness skin left. Residual glandular tissue was removed with serrated edge curettage. After adequate irrigation and hemostasis, a drainage strip was placed in the incision. Then, we evenly divided the surgical area into 8 sections. In the center of each section, a draining hole was made. Of the 88 axillae, malodor was eradicated in 84 and considerably reduced in 4. Although 6 arms had temporary edema, and 10 axillae experienced superficial epidermal necrosis, no full-thickness skin necrosis was observed. Complications like hematoma, seroma, and infection were not present in all cases. All the scars of the incision and drainage holes were inconspicuous. The use of small incisions in the posterior axillary wall could accomplish sweat gland elimination and simultaneously provide excellent drainage. Combining this with porous drainage can effectively prevent hematoma, skin necrosis, and scar formation.

Videoscope-Assisted Minimally Invasive Surgery (VMIS) for Bone Regeneration around Teeth and Implants: A Literature Review and Technique Update.

Background—The literature related to minimally invasive periodontal surgery is reviewed. This includes the original minimally invasive surgery (MIS) procedure for bone regeneration, the modification of MIS for the minimally invasive surgery technique (MIST) and modified MIST (M-MIST) procedures, and the introduction of the videoscope for oral surgical procedures and the ability to perform videoscope-assisted minimally invasive surgery (VMIS). The evolution from MIS through MIST to the current VMIS is reviewed. The results from studies of each of these methods are reported. Conclusion—The use of small incisions that produce minimal trauma and preserve most of the blood supply to the periodontal and peri-implant tissues results in improved regenerative outcomes, minimal to absent negative esthetic outcomes, and little or no patient discomfort. Minimally invasive procedures are a reliable method to regenerate periodontal tissues.

Pain management using acetaminophen throughout postoperative course of laparoscopic colorectal surgery: A case-matched control study.

BackgroudThe main advantage of laparoscopic surgery is that it is minimally invasive because of the use of small incisions. An approach using small incisions offers many benefits including attenuation of surgical wound pain. However, the presence of postoperative pain may undermine the advantages of laparoscopic surgery as a minimally invasive technique. In addition, perioperative pain management is an important factor affecting recovery after surgery. This study investigated the usefulness of a multimodal approach to postoperative pain management with acetaminophen as a baseline analgesic after minimally invasive laparoscopic colorectal surgery.Materials and methodsThe study included 40 patients who underwent laparoscopic colorectal surgery for colorectal cancer. 20 patients received acetaminophen as a baseline analgesic for postoperative pain management and 20 received epidural anesthesia.ResultsThe urethral catheter could be removed earlier in the acetaminophen group (2.1 ± 0.22 days postoperatively) compared with the epidural group (4.1 ± 0.45days postoperatively). The frequencies of vertigo were significantly lower in the acetaminophen than epidural group (10.0% and 45.0%, respectively). The frequencies of the use of analgesics on an as-needed basis for postoperative pain relief as well as the variabilities in these frequencies, although not significantly different between the acetaminophen and epidural groups, were lower in the acetaminophen group than the epidural group.ConclusionWe herein demonstrated that postoperative pain management with acetaminophen as a baseline analgesic, and without the use of epidural anesthesia, is a safe and useful analgesic modality.

A Short Note on Minimally Invasive Lumbar Spine Surgery

Almost all spine surgeons tout minimally Invasiveness in spine surgery as a beneficial focus. The meaning of minimally invasiveness, however, is actually a concept with different meanings for each surgeon. To some, it is the use of smaller incisions using standard surgical approaches, the use of tubular retractors, and/or the use of surgical magnification with a microscope, or an endoscope. Minimally invasiveness often advertises the use of lasers as a sexy and high tech surgical tool to tout their state- of- the- art surgical technique in minimally invasiveness, but it is not used as a needed part of the surgery unless visually used with endoscopes under irrigation.

How Surgical Care is Changing in the Technological Era

It is undoubted that in the last 20 years technology has changed surgical care, which is now evolving rapidly following the introduction and expansion of minimally invasive surgery and the utilization of tablets and smartphones to communicate between patients and doctors, or between doctors themselves (mobile healthcare). In this article, I try briefly to analyze how these two major changes may bring a new dimension to the future of worldwide healthcare, using the example of thoracic surgery. To begin, the introduction in 1998 of the ‘uniportal’ surgery today permits us to perform many operations in thoracic and abdominal surgery through a single small skin incision [1–6]. Uniportal video-assisted surgery is more and more often used worldwide, and is currently performed by a team formed by one or two surgeons. This is less than 20 years ago, and therefore it can be envisioned that in the future we could certainly need fewer surgeons [7]. Moreover, the fact that surgical skills needed to operate through a small incision must be prominent, it will be necessary for the surgeon to undergo specific training to acquire the necessary elevated surgical capability to operate on patients [2]. I envisage, for the benefit of our patients, that every complex operation could be watched by ‘expert surgeons’ who, in a supervisory room, act as live councilors for when an intraoperative doubt arises – this could decrease intraoperative risks and give better long-term results. Of note here is that use of smaller incisions to treat cancer should never place patients at risk, and the uniportal surgery would require approval by scientific societies following evidence of improvement of patient outcomes, or at least maintenance of the same outcomes, for benign and malignant diseases. I agree with the unpublished words of T Treasure that these techniques are not for every surgeon to explore, but if proven to be in a patient’s best interests, they should not be avoided but adopted. The big question is therefore how to test whether innovations are true improvements, using randomized trials. Another point of future discussion is how to train our next generation of surgeons, who must use both hands to operate through a small entry in the chest or abdomen; of course, this will be facilitated in the case of robotic surgery as the surgeon will operate via the console. Next, we will consider the use of mobile technology such as smartphones or tablets in medicine, which permit that images files (x-rays, CT-scan, angiography etc.) could be transferred through social media applications such as Whatsapp; the consultant can therefore see the images within a few seconds from home or wherever he\she is, and consequently medical opinions can be delivered to the resident without hesitation and without the need to reach the hospital, as was How surgical care is changing in the technological era

Effect of Umbilical Port and Endoscope Size on Discharge Times and Postoperative Recovery After Total Laparoscopic Hysterectomy: A Retrospective Review

Background: Laparoscopy is increasingly replacing open surgery as the preferred treatment option in most patients across disciplines. In addition, as technological improvements have occurred, minilaparoscopic instruments have been designed to reduce surgical trauma further and minimize invasiveness. Several studies in the literature have shown that using minilaparoscopic instruments does not increase complication rates and may improve patient recovery. There are no data examining the use of smaller incisions for the endoscope. Objective: This review was conducted to determine differences in discharge times and postoperative recovery when using a 5-mm trocar, compared to a 10-mm trocar, when making umbilical incisions. Materials and Methods: This retrospective review of a single surgeon series of 328 consecutive cases examined the implications (discharge times and postoperative recovery) of using a 5-mm umbilical incision and endoscope, compared with the conventional 10-mm incision and endoscope. Results: The 5-mm incision and endoscope decreased length of stay and was a safe alternative to the 10-mm incision and endoscope. Conclusions: The 5-mm incision and trocar should be used rather than the 10-mm incision and trocar when performing a total laparoscopic hysterectomy. (J GYNECOL SURG 30:273)

Embolização das artérias uterinas com partículas de PVA-PVAC esférico como preparo para posterior ressecção cirúrgica de miomas

To evaluate the use of a new spherical particle of polyvinyl alcohol and polyvinyl acetate (PVA-PVAc) for uterine artery embolization in patients with myoma with surgical indication. twelve patients underwent uterine myoma embolization with PVA-PVAc particles. Three to nine months later, they were submitted to laparotomy with myomectomy. We analyzed the following parameters: volume of the uterus and of the bigger myoma; concentrations of follicle stimulating hormone and hemoglobin; menstrual bleeding (number of days and used absorbents), signs and symptoms before treatment, after embolization and after myomectomy. The mean age was 37 years and mean uterine volume prior to treatment, 939.3 cc. Three years after embolization, there was reduction in uterine volume (p = 0.0005), increase in hemoglobin concentration after embolization (p = 0.0004), without variation after the myomectomy. There was no significant variation of the follicle stimulating hormone (p = 0.17). There was no case of ovarian failure, but one of the patients had endometrial atrophy. Two patients became pregnant, with good obstetric indicators. Signs and symptoms improved after embolization, and remained after myomectomy. Arterial embolization with spherical PVA-PVAc particles is promising in the preparation for myoma surgery, since it was associated with a reduction in uterine volume, decrease in intraoperative bleeding and made possible the use of smaller incisions, increasing the chance of preserving the uterus.

Comment on Tong et al.: Two-stage procedure protocol for minimally invasive plate osteosynthesis technique in the treatment of the complex pilon fracture

Dear Editor, We have read with great interest the article entitled “Two-stage procedure protocol for minimally invasive plate osteosynthesis technique in the treatment of the complex pilon fracture” by Tong et al. [4]. They describe a two-stage procedure combined with the MIPO technique to treat AO/OTA type C pilon fractures and conclud that this protocol could result in a low infection rate associated with open reduction and internal fixation (ORIF). The limited series achieved good outcomes at an average follow-up of 24 months. However, there are some concerns regarding this study. First, which types of pilon fractures would be suitable for the MIPO technique? The authors used this technique to treat all type C pilon fractures (C1, C2 and C3 were included) and achieved good outcomes, but we do not think this is the best choice for all type C pilon fractures. Undoubtedly, the minimally invasive procedure would minimise surgical trauma and lessen the soft tissue complications. However, we should not forget that most common type C pilon fractures are usually caused by high energy forces and characterised by the severe comminution of the articular surface, especially the type C3 fractures. MIPO emphasises the use of small incisions to restore mechanical axes, decrease tissue injury and preserve blood supply. The procedure appears soft tissue friendly. However, it would cause great difficulty with the articular reduction. The limited incision is usually not large enough to allow direct manipulation of fractured fragments and visualisation of the joint surface. Although the authors mentioned the use of additional punctiform incisions to assist reduction, we believe that it would be not so easy to reduce the comminuted fragments, especially the die-punch fragments. This is partly because the time interval between the first and the second stage was too long in this study. The relatively long time interval, which was from 24 to 38 days, may allow the formation of bony callus. This would make the reduction of both the articular and the metaphyseal fragments too difficult, even if they were approached directly. The unsatisfactory articular reduction would lead to post-traumatic arthritis. This can be certified by another study. Borens et al. [1] who retrospectively evaluated 17 patients with type C pilon fractures, who were treated using MIPO techniques. Articular reduction was maintained in only four patients and seven patients developed moderate arthritis, so the authors recommended using this technique for fractures with simple articular involvement. As far as we are concerned the MIPO technique might be more suitable for type C1 and a few type C2 fractures but not type C pilon fractures. Second, the authors reported there was no infection. They attributed this to the staged procedure in conjunction with the MIPO technique. Whilst agreeing with this view, we thought, in addition to the surgical timing and minimal soft tissue disturbance, the infection rate and wound healing problems are associated with many other aspects, such as the timing of debridement, the fracture patterns, the incidence of open fractures, use of antibiotics and so on. Unfortunately, in this study, we are unable to find detailed information about the timing of debridement, the exact account of each subtype of type C fractures and the accurate number of each subtype of Gustilo type C open fractures. The Gustilo classification has an intimate relationship with the infection. Since 83 % of the patients had closed fractures and Gustilo type B open fractures, the low proportion of Gustilo type C fractures might also contribute to the good outcomes. With regard to the surgical timing, delayed surgery gave the soft tissue the chance to recover. Perhaps, just like many reports in the literature [2, 3], conventional ORIF would also achieve a good result with the tissue’s restoration after a long time, and would also be more helpful in reduction of the articular surface. Third, the authors reported that all patients had normal functioning ankle joints. They identified the outcomes according to the objective criteria (the amount of post-traumatic arthritis, range of ankle movement, number of arthrodeses) and the subjective criteria (pain, swelling, restriction of work or leisure activities). But they only mentioned this in the abstract. Focusing on the whole paper, we cannot know how many patients developed arthritis, how many degrees the range of motion was and which criteria the authors chose, the Mazur scale, the SF-36 scale, the AOFAS scale, the Olerud-Molander scale or the others? “All patients attained normal function in the ankle joints” was ambiguous and could not explain everything. For most type C pilon fractures, one of the major complications is arthritis. Sometimes, many patients with post-traumatic arthritis confirmed by radiography report normal function of the ankle [5]. Besides, in a two year follow-up, perhaps the mild or moderate arthritis had not developed to the level to affect the range of motion.

(v) Unicompartmental knee arthroplasty

Abstract Unicompartmental knee arthroplasty (UKA) is a treatment option when only one compartment of the knee is affected with arthritis. There has been increasing enthusiasm in unicompartmental knee arthroplasty, with improved understanding of surgical principles, newer techniques for improving surgical precision including the use of smaller incisions, and the introduction of newer designs. Past experiences from several centres have been paramount in the education of surgeons with regards to patient selection, technical considerations, and importantly avoiding common pitfalls can lead to early failure of the components.

Design of a Flexible Imaging Probe for Robotics Surgery

Minimally invasive surgery assisted by robots has shown higher efficiency and precision. In spite of the good performance of the state of the art surgery robotics systems, the size and number of external incisions required by instruments should be reduced to lower the scarring and incisional pain experienced by the patient. Other important improvement derived from the use of smaller incisions is the diminishment of time required for recovery. This research develops a flexible scope of small diameter driven by segmented multiple actuators to produce a deflection of the imaging probe at its distal end providing better visualization than the current rigid cameras. The research is conducted in cooperation with the Biorobotics Laboratory at the University of Washington USA, where our scope will be incorporated to Raven, a 7-DOF cable-actuated surgical robot. The flexible scope is composed of three segments as illustrated in Figure 1, where it is possible to see that the device contains a ring of cables enclosed externally and internally by two different springs and a semi rigid covering. The main mechanism of bending is the compression and extension of the external spring at the distal end. The change of length in this spring is controlled by an active system that combines pulling and releasing actions through the ring of cables. The device has advantages in its simplicity of actuation and the high elasticity and flexibility at the distal end. In the current state of the project, a testing system is under construction.

Acute inflammatory response to colorectal cancer resection according to different laparotomy incision lengths

The small-, medium-, and large-incision groups included 68 (51.9%), 42, (32.1%) and 21 (16.0%) patients, respectively. On the 1st postoperative day, median serum levels of CRP and WBC of the small-incision group were significantly lower than those of the medium-incision and large-incision groups (CRP, P=0.0051 and P=0.0015, respectively; WBC, P=0.049 and P =0.0007, respectively). In addition, the median serum levels of CRP and WBC on the 1st postoperative day were proportional to the length of laparotomy. These data suggested that the extent of acute inflammatory response may be proportional to length of laparotomy. In addition, only the use of small-incisions ( 7 cm) among the three investigated categories of laparotomy lengths may be a factor which is associated with statistical significance with minimal invasiveness of colorectal cancer resection. ACTA MEDICA NAGASAKIENSIA 56: 13－18, 2011

The minimally-invasive thyroidectomy incision: A histological analysis

SummaryBackgroundMinimally invasive thyroidectomy (MIT) has gained popularity in the surgical management of benign and malignant pathology of the thyroid. One of the main benefits of utilizing this technique is the use of smaller incisions resulting in increased cosmetic satisfaction. Unfortunately, the retraction required for adequate exposure during MIT may lead to skin damage, impaired wound healing and poor cosmetic outcomes. Some have proposed that excising incision edges prior to closure may improve cosmesis. A review of the literature does not reveal any histologic evidence to support this technique.Material/MethodsIn this prospective observational study, nine subjects undergoing MIT were identified. Both the superior and inferior skin edges were excised and labeled for orientation. Specimens were sent for hematoxylin and eosin staining and histologic analysis by a staff pathologist.ResultsAll specimens showed no significant findings such as damage to the architecture of the dermis, acute inflammation, edema or evidence of hemorrhage. Focal blood vessel ectasia within the dermis was identified in three of nine subjects.ConclusionsOur findings do not yield a histological basis supporting the routine trimming of incisions during MIT. Although no significant findings were noted histologically, further studies are warranted to investigate the long-term cosmetic outcome of MIT incisions.

Endoscopic tissue expansion placement in face and neck burn scar reconstruction

Introduction Reconstruction of the face and neck after burn necessitates high-quality tissue for improving the appearance. Tissue expansion provides a greater opportunity, but, unfortunately, with relatively high complication rates. One potential alternative to reduce these complications is to place the expander with the assistance of the endoscope. In this study, we evaluated endoscopically assisted tissue-expander placement for the treatment of face and neck deformities after burn. Materials and methods Age, gender, site of burn to be reconstructed, shape and volume of expander inserted, expander volume reached after expansion, time reached to maximum volume expansion and complications for all patients having undergone endoscopically assisted tissue-expander placement were recorded during the period of the study. The details of the procedure used were described. Results A total of 14 expanders were placed assisted by an endoscope in 11 patients between April 2008 and October 2009. Anatomically, five expanders were placed in the neck, six expanders were placed in the cheek and three expanders were placed in the forehead. In all cases, tissue expansion was achieved without major complications; minor port complications occurred in two cases. Conclusion Endoscopically assisted tissue-expander placement allows for the use of smaller incisions, which can be placed in more cosmetically acceptable areas and away from the expansion site. This benefit would reduce the risk of wound dehiscence, and permits expansion to be initiated earlier. We believe that this technique is a safe and effective method that needs to be confirmed with a comparative study.

A Prospective Randomized Trial of Mini-incision Posterior and Two-incision Total Hip Arthroplasty

The two-incision approach to THA has been controversial, with some authors reporting its use is associated with a rapid recovery whereas others report no differences in outcomes and a higher risk of perioperative complications secondary to increased surgical complexity. We therefore compared early postoperative variables including pain, length of stay, functional recovery, complications, and complexity of the mini-posterior and two-incision approaches to THA. We prospectively enrolled 72 patients scheduled for THA and randomized them into two groups: mini-incision posterior approach and the two-incision approach. Preoperative teaching, anesthetic protocols, implants used, and rehabilitation pathways were identical for both groups. All variables were assessed at a maximum of 1 year postoperatively. All key outcomes were similar in the two groups: mean visual analog scale (VAS) scores for pain during the first 3 postoperative days and the first 6 weeks, total narcotic requirements in the hospital and during the first 6 weeks, mean length of stay (51 hours versus 48 hours), and mean Harris hip scores and SF-12 scores. Achievement of functional milestones was similar between the two groups. There was one reoperation in each group. Mean operative time was longer for patients in the two-incision group (98 minutes versus 77 minutes), however the accuracy of component positioning was similar. We found no differences in perioperative outcomes between these two approaches for THA. Variables other than the surgical approach including perioperative protocols, patient expectations, and the patient's general health may have a greater effect on outcomes such as pain during the early postoperative period, functional recovery, and length of hospital stay. The use of small incisions for THA was safe as was a shortened hospital stay in selected patients.

“Cutting for love”: genital incisions to enhance sexual desirability and commitment in KwaZulu-Natal, South Africa

Several studies have documented women's use of vaginal practices in South Africa to enhance their desirability to men. This article describes a little known practice of this kind among women in KwaZulu-Natal. It involves the use of small incisions in the genital area (and often abdomen and breasts) to introduce herbal substances, described as love medicines, into the body through the incisions. In-depth interviews were carried out with 20 key informants and 20 women, and eight focus group discussions with women and men, in a rural and urban site in 2005–06. A province-wide household survey was then conducted using a multi-stage cluster sample design among 867 women aged 18–60. Forty-two per cent of the women in the household survey had heard of genital incisions; only 3% had actually used them. The main motivation was the enhancement of sexual attractiveness and long-term partner commitment. It appears to be a very recent practice, but may be an extension of an older healing practice not involving the genitals. It was most prevalent among rural women aged 24–29 (although not significant), those with less education, and those who suspected their partners of having other partners. It is linked to the modern popularity of love medicines, which in turn illustrates the troubling state of gender relations in KwaZulu-Natal today.

Unusual fishing harpoon injury of the maxillofacial region in a child

Injuries by fishing harpoon are extremely rare. Despite the similarities to other penetrating injuries normally caused by gunshot and stab wounds, harpoon injuries feature hook-type tips pointing to the opposite direction to that of removal, thus rendering the surgery more complex. The authors report on a case of a child who sustained an injury caused by two-piece fragments of a fishing harpoon to the right temporal and orbital regions. The diagnosis process is discussed and a suggestion is presented as to treatment principles. The authors support the use of small incisions that are just small enough to clear the tissues surrounding the object and allow for the removal of said object from the outside to the inside and counter indicate any attempt to pull the object. Such approach was used in this case with a satisfactory result and minimum sequels.

Critical appraisal of outcomes following open radical prostatectomy

Radical prostatectomy has evolved enormously over the last 25 years. Improvements include the use of smaller incisions, reduced blood loss, shorter hospital stays, and surgical refinement to improve the recovery of continence and potency. In addition, new technologies and minimally invasive techniques with the potential to further improve patient outcomes have been introduced. This article focuses on outcomes with open radical prostatectomy and is not meant to compare open radical prostatectomy and minimally invasive approaches. Despite a lack of randomized controlled trials, strong observational cohort studies demonstrate lower rates of positive surgical margins, high 10-year and 15-year biochemical recurrence-free rates, excellent prostate cancer-specific mortality rates, and improved recovery of urinary incontinence and erectile function after open radical prostatectomy. We review publications from the past 24 months regarding oncologic outcome, continence, and erectile function, as well as some earlier manuscripts that emphasize key aspects of open radical prostatectomy. Today open radical prostatectomy is a less-invasive procedure with low morbidity providing excellent control of clinically localized prostate cancer. Although open radical prostatectomy now accounts for a minority of radical prostatectomies in the United States, the concepts that have improved oncologic and quality-of-life outcomes are equally applicable to minimally invasive procedures.