[Robot assisted radical prostatectomy: What are the evidences at the time of a specific funding?]
BACKGROUND
Despite a decreasing number of radical prostatectomies in France, the number of robot-assisted surgeries increases. The objective of this work is to assess the interest of robotic prostatectomy before asking a specific funding from health authorities.


METHODS
A systematic review of the literature on PubMed was performed. Prospective studies and meta-analyses comparing robot-assisted radical prostatectomy (RARP), laparoscopic (LRP) and open surgery (OP) were selected.


RESULTS
There are only two randomized clinical trials comparing RARP and LRP. Erectile function was significantly better after RARP than after LRP. Compared to OP, sexuality evaluation, based on meta-analyses, was significantly better at 12 months and the absolute risk of erectile dysfunction significantly decreased. Continence after RARP was significantly better than LRP 3 months after surgery. Compared to OP, continence results were discordant, sometimes significantly in favor of RARP, sometimes similar. The rate of positive margins was similar whatever the technique. The long-term oncological outcomes were similar. In terms of perioperative complications, no significant difference was observed between RARP and LRP or OP.


CONCLUSIONS
RARP provides same oncological outcomes as the open and laparoscopic approach. Continence and sexuality are better after RARP than after laparoscopic or open surgery. However, no randomized study comparing RARP and OP is available.
Service d'urologie, CHU de Grenoble, 38043 Grenoble cedex 9, France; TIMC-IMAG, CNRS 5525, domaine de la Merci, 38700 La Tronche, France. Electronic address: JALong@chu-grenoble.fr.
J-A
JA
Long
Clinique Beau Soleil, Montpellier, France.
G
G
Poinas
Service d'urologie, CHU de Grenoble, 38043 Grenoble cedex 9, France; TIMC-IMAG, CNRS 5525, domaine de la Merci, 38700 La Tronche, France.
G
G
Fiard
Mapigroup, Lyon, France.
M
M
Leprêtre
Mapigroup, Lyon, France.
C
C
Delaitre-Bonnin
Clinique Beau Soleil, Montpellier, France; Association française d'urologie (AFU), Paris, France.
X
X
Rébillard
Service d'urologie, CHU de Grenoble, 38043 Grenoble cedex 9, France; TIMC-IMAG, CNRS 5525, domaine de la Merci, 38700 La Tronche, France; Association française d'urologie (AFU), Paris, France.
J-L
JL
Descotes
D007172:Erectile Dysfunction / Q000517:prevention & control; D006801:Humans; D010535:Laparoscopy; D008297:Male; D011468:Prostatectomy / Q000009:adverse effects / Q000379:methods*; D011471:Prostatic Neoplasms / Q000601:surgery; D065287:Robotic Surgical Procedures; D014549:Urinary Incontinence / Q000517:prevention & control
Cancer de prostate; Functional outcomes; Oncological outcomes; Prostate cancer; Prostatectomie radicale; Radical prostatectomy; Robotics; Robotique; Résultats fonctionnels; Résultats oncologiques