Status of radical prostatectomy in 2009: is there medical evidence to justify the robotic approach?
This article presents the evolution of open radical retropubic prostatectomy (ORRP) into a minimally invasive procedure and reviews the literature to provide a legitimate comparison between ORRP and robotic-assisted laparoscopic radical retropubic prostatectomy (RALRP). The article is limited to manuscripts cited in the peer-reviewed literature, and an effort was made to identify those articles that fulfilled the highest level of medical evidence. In centers of excellence, ORRP is performed with no mortality, extraordinarily low technical and medical complications (1%), the rare need for blood transfusions, 1- to 2-day hospital stays, urinary catheters that are routinely removed in a week, the majority of men returning to work in 2 weeks, and up to 97% of men regaining urinary continence. Return of potency remains a challenge, especially for older men with marginal erections. RALRP is now the most common approach for the surgical removal of the malignant prostate. A critical review of the literature fails to support the marketing claims that RALRP is associated with shorter hospitalization, less pain, better cosmetics, shorter catheter time, lower transfusion rates, or improved continence and potency rates. The highest level of medical evidence suggests that RALRP may significantly compromise oncologic outcomes and that men undergoing this approach have higher regret rates than men undergoing ORRP.
Lepor
Herbert
H
New York University School of Medicine New York, NY.
Urology. 2001 Sep;58(3):425-9
11549493
Rev Urol. 2001 Summer;3(3):113-9
16985703
Rev Urol. 2008 Fall;10(4):245-53
19145268
J Urol. 2004 Mar;171(3):1212-5
14767304
J Urol. 2005 Sep;174(3):912-4; discussion 914
16093986
Rev Urol. 2005 Summer;7(3):115-27
16985822
J Urol. 1979 Feb;121(2):198-200
423333
J Urol. 2007 Mar;177(3):929-31
17296378
Cancer Invest. 2004;22(3):435-44
15493364
J Urol. 2001 Nov;166(5):1729-33
11586211
Urology. 2003 Jan;61(1):156-60
12559288
J Clin Oncol. 2008 May 10;26(14):2278-84
18467718
J Urol. 1999 Aug;162(2):433-8
10411052
Urology. 2003 Oct;62(4):702-6
14550447
Urol Clin North Am. 2001 Aug;28(3):639-53
11590819
J Urol. 1991 Mar;145(3):512-4; discussion 514-5
1997701
Urology. 2010 Jun;75(6):1424-8
20513505
J Urol. 1985 Feb;133(2):207-12
3968733
Urology. 2001 Apr;57(4):737-41
11306393
J Urol. 2006 Oct;176(4 Pt 1):1420-3
16952648
Urology. 2001 Apr;57(4):742-6
11306394
Urol Clin North Am. 2001 Aug;28(3):613-27
11590817
J Urol. 2003 Jun;169(6):2147-52
12771737
BJU Int. 2003 Aug;92(3):205-10
12887468
N Engl J Med. 2008 Mar 20;358(12):1250-61
18354103
Urol Clin North Am. 2009 May;36(2):237-49, ix
19406324
J Urol. 2009 Apr;181(4):1817-22
19233413
Urology. 2005 Jul;66(1):141-6
15992906
J Urol. 1994 May;151(5):1283-90
7512659
Urol Oncol. 2011 Jul-Aug;29(4):388-92
19762254
J Urol. 2000 Mar;163(3):829-33
10687987
J Clin Oncol. 2005 Nov 10;23(32):8170-5
16278469
Int J Impot Res. 2008 Sep-Oct;20(5):479-86
18650827
J Urol. 2009 Feb;181(2):462-71
19084865
J Urol. 1994 Nov;152(5 Pt 2):1831-6
7523730
Cancer. 1987 Aug 1;60(3 Suppl):526-37
3594391
BJU Int. 2007 May;99(5):1103-8
17309550
J Urol. 2008 Dec;180(6):2459-62
18930492
J Urol. 2001 Jun;165(6 Pt 1):1943-8; discussion 1948-9
11371886
J Urol. 2001 Aug;166(2):416-9
11458039
J Urol. 1982 Apr;127(4):704-6
7069835
Eur Urol. 2008 Oct;54(4):785-93
18585849
BJU Int. 2006 Feb;97(2):255-8
16430623
J Urol. 1982 Sep;128(3):492-7
7120554
JAMA. 1997 May 14;277(18):1452-5
9145717