Robotic surgery in prostate cancer

Abstract

Prostate cancer is the second most common malignancy in men (excluding skin cancer) behind lung cancer, with more than one million cases estimated to be diagnosed worldwide in 2016. Radical prostatectomy (RP) has been the most widely used approach for the treatment of organ-confined prostate cancer. However, the high incidence of perioperative morbidities and functional derangements related with open radical retropubic prostatectomy (RRP) has led to the search for less invasive treatments to improve oncological outcomes and quality of life issues. Binder and Kramer were the first to report the feasibility of robotassisted laparoscopic radical prostatectomy in 2001, and the Vattikuti Urology Institute at Henry Ford Hospital in Detroit, Michigan, USA, pioneered the establishment of urologic robotic surgery programs worldwide. The application of robotic technology in surgical practice has developed tremendously over the past three decades. Urologists in particular have embraced surgical robots throughout their evolution, and robot-assisted urologic surgeries have matured into everyday clinical practice in many parts of the world. Herein, we will review the available literature data about robotic surgery in prostate cancer concentrating mainly on the evolution and adaptation of robot-assisted radical prostatectomy (RARP), its perioperative/functional/oncological outcomes, results of comparative studies with open/laparoscopic RP, and relevant future directions related with optimization of RARP outcomes.