Evolution of robot-assisted radical prostatectomy.

INTRODUCTION AND OBJECTIVE: Open radical prostatectomy (RRP) is the gold standard and most widespread treatment for clinically localized prostate cancer. However, in recent years robot-assisted laparoscopic prostatectomy (RARP) is rapidly gaining acceptance among urologists worldwide. We sought to outline our surgical technique of robotic radical prostatectomy and provide practical recommendations based on available reports and personal experience. We also critically review the current experience on RARP worldwide and compare the available data with the gold standard open RRP series.

MATERIAL AND METHODS: A systematic review of the literature was performed for all published manuscripts between 1997 and 2008 using the keywords - 'robotic radical prostatectomy, 'robot-assisted radical prostatectomy', 'laparoscopic radical prostatectomy' and 'robotic' using the Medline database.

RESULTS: A total of 226 original manuscripts on RARP were identified. Manuscripts were selected according to their relevance to the current topic (i.e. original articles, number of patients in the series, prospective data collection) and incorporated into this review.

CONCLUSIONS: Eight years after the first RARP, multiple series are mature enough to demonstrate safety, efficiency and reproducibility of the procedure, as well as oncologic and functional outcomes comparable to its open counterpart. Further prospective, randomized studies comparing both surgical techniques are necessary in order to draw more definitive conclusions.