Robot-Assisted Simple Prostatectomy: Expanding on an Established Operative Approach

The leading cause of voiding dysfunction in older men is benign prostatic obstruction. In the setting of a grossly enlarged prostate (>80cm³), an open simple prostatectomy has been the gold standard for surgical treatment. Here, we will discuss the minimally invasive robot-assisted approach and compare it to the classic open approach and holmium laser enucleation of the prostate.

Literature on robot-assisted simple prostatectomy, in concurrence with our institutional experience, has shown an overall lower morbidity, shorter hospital stay, and decreased indwelling catheter time, with equivalent functional outcomes compared to open simple prostatectomy. Similar operative times and hospital stays were found compared to holmium laser enucleation of the prostate, although a steep learning curve and cost of new equipment hinder the wide spread use of this transurethral approach. On review of current literature in addition to our institutional experience, we favor robot-assisted simple prostatectomy over open simple, based on associated increased morbidity/catheter time/hospital stay, and holium laser enucleation of the prostate, based on steep learning curve and cost of new equipment.