Pure and robotic-assisted laparoscopic radical prostatectomy: technology and techniques merge to improve outcomes

Laparoscopic radical prostatectomy is rapidly becoming the preferred approach in the surgical management of prostate cancer. The enhanced visibility provided to the surgeon by magnification allows for a better definition of anatomical landmarks, which were not apparent with open, nonmagnified surgery. Recent descriptions of the periprostatic anatomy, including the fascial layers surrounding the prostate, the structure of the neurovascular bundles and the components of the urethral sphincteric complex, allow the surgeon to refine available surgical techniques and create new ones with the goal of maximizing potency and continence preservation. The advent of the da Vinci robot to assist laparoscopic surgery served as a platform to enhance the surgeon' laparoscopic skills and to define further technological needs, such as better 3D vision systems and the development of hand-held articulating instruments that maintain haptic perception. This review summarizes the newer technologies available, recent anatomical descriptions of the periprostatic area and refinements in technique. The ultimate goal of the merge of technology with refinements in technique and a better anatomical understanding is to continue to improve the surgical outcomes with laparoscopy.