title: Best practices in robot-assisted radical prostatectomy: recommendations of the Pasadena Consensus Panel.
abstract: BACKGROUND
  Radical retropubic prostatectomy (RRP) has long been the most common surgical technique used to treat clinically localized prostate cancer (PCa). More recently, robot-assisted radical prostatectomy (RARP) has been gaining increasing acceptance among patients and urologists, and it has become the dominant technique in the United States despite a paucity of prospective studies or randomized trials supporting its superiority over RRP.
  
  
  OBJECTIVE
  A 2-d consensus conference of 17 world leaders in prostate cancer and radical prostatectomy was organized in Pasadena, California, and at the City of Hope Cancer Center, Duarte, California, under the auspices of the European Association of Urology Robotic Urology Section to systematically review the currently available data on RARP, to critically assess current surgical techniques, and to generate best practice recommendations to guide clinicians and related medical personnel. No commercial support was obtained for the conference.
  
  
  METHODS
  A systematic review of the literature was performed in agreement with the Preferred Reporting Items for Systematic Reviews and Meta-analysis statement.
  
  
  RESULTS
  The results of the systematic literature review were reviewed, discussed, and refined over the 2-d conference. Key recommendations were generated using a Delphi consensus approach. RARP is associated with less blood loss and transfusion rates compared with RRP, and there appear to be minimal differences between the two approaches in terms of overall postoperative complications. Positive surgical margin rates are at least equivalent with RARP, but firm conclusions about biochemical recurrence and other oncologic end points are difficult to draw because the follow-up in existing studies is relatively short and the overall experience with RARP in locally advanced PCa is still limited. RARP may offer advantages in postoperative recovery of urinary continence and erectile function, although there are methodological limitations in most studies to date and a need for well-controlled comparative outcomes studies of radical prostatectomy surgery following best practice guidelines. Surgeon experience and institutional volume of procedures strongly predict better outcomes in all relevant domains.
  
  
  CONCLUSIONS
  Available evidence suggests that RARP is a valuable therapeutic option for clinically localized PCa. Further research is needed to clarify the actual role of RARP in patients with locally advanced disease.
authors: Vita-Salute San Raffaele University, Milan, Italy. montorsi.francesco@hsr.it
authors: Francesco
authors: F
authors: Montorsi
authors: Timothy G
authors: TG
authors: Wilson
authors: Raymond C
authors: RC
authors: Rosen
authors: Thomas E
authors: TE
authors: Ahlering
authors: Walter
authors: W
authors: Artibani
authors: Peter R
authors: PR
authors: Carroll
authors: Anthony
authors: A
authors: Costello
authors: James A
authors: JA
authors: Eastham
authors: Vincenzo
authors: V
authors: Ficarra
authors: Giorgio
authors: G
authors: Guazzoni
authors: Mani
authors: M
authors: Menon
authors: Giacomo
authors: G
authors: Novara
authors: Vipul R
authors: VR
authors: Patel
authors: Jens-Uwe
authors: JU
authors: Stolzenburg
authors: Henk
authors: H
authors: Van der Poel
authors: Hein
authors: H
authors: Van Poppel
authors: Alexandre
authors: A
authors: Mottrie
mesh_terms: D019985:Benchmarking / Q000592:standards*; D032921:Consensus; D003697:Delphi Technique; D019317:Evidence-Based Medicine / Q000592:standards; D006801:Humans; D010535:Laparoscopy / Q000592:standards*; D008297:Male; D011183:Postoperative Complications / Q000209:etiology; D011468:Prostatectomy / Q000009:adverse effects / Q000379:methods / Q000592:standards*; D011471:Prostatic Neoplasms / Q000473:pathology / Q000601:surgery*; D018570:Risk Assessment; D012307:Risk Factors; D012371:Robotics / Q000592:standards*; D025321:Surgery, Computer-Assisted / Q000009:adverse effects / Q000592:standards*; D016896:Treatment Outcome