Robot-assisted radical prostatectomy: A prostate surgeon’s perspective

Abstract

The availability and promulgation of robotic technology have resulted in a paradigm shift in the use of radical prostatectomy. Historically radical prostatectomy was performed using an open approach, usually the retropubic approach and rarely using a laparoscopic approach. Recently, however, robotic-assisted radical prostatectomy (RARP) [1] has swept across the United States at an extremely rapid rate, accounting for greater than 85% of cases performed in 2011 [2, 3]. While the early adopters and promoters of RARP were laparoendoscopic specialists, the robotic-assisted approach is becoming the procedure of choice for urologic oncologists as well. In addition, residents are being trained in the use of such technology. The actual costs, benefits, and risks of robotic as compared to open radical prostatectomy remain somewhat controversial. Often lost in such debate is the role of radical prostatectomy, by whatever approach, in the management of prostate cancer, given the considerable stage/grade migration that has occurred because of widespread PSA testing and the mounting concerns regarding prostate cancer over detection and treatment.