Robotic radical prostatectomy: long-term outcomes

In 2001, approximately 250 robotic-assisted laparoscopic prostatectomies were performed; in 2007, this number is expected to approach 50,000 surgeries. This surge has arguably been driven by the improved (real or perceived) clinical outcomes. In this review we assess 'long-term' experience based on reports recently published over the past 18 months.

The short-term clinical outcomes for robotic-assisted laparoscopic prostatectomies such as deaths, transfusions, postoperative complications and bladder neck contractures are excellent, and appear to be improved when compared to open radical retropubic prostatectomy. Recent findings regarding the early return of potency have emphasized the benefit of avoiding thermal energy when preserving the neurovascular bundle. In similar fashion, early continence rates appear to be improved by restoring posterior anatomic fascia. Local disease control as measured by surgical margin status appears to be at least equivalent to contemporary open series, but longer follow-up is needed.

Three-dimensional and 10 times magnified vision, precise instrument control, and improved exposure coupled with the tamponade effect associated with the pneumoperitoneum have translated into reproducible improvements in patient comfort, and decreased mortality, blood loss and complications, including bladder neck contracture and deep venous thrombosis. These technical improvements would lead one to believe that improved results with continence, potency and oncologic outcomes should logically follow. Ultimately, long-term outcomes and possibly financial impact will determine the role of robotic-assisted laparoscopic prostatectomy.