Has robotic prostatectomy determined the fall of the laparoscopic approach?

Abstract

Robotic Assisted Laparoscopic Prostatectomy (RALP) has revolutionised the surgical management of localised Prostate Cancer in the modern era. The surgeon is provided with greater precision, more versatile dexterity and an immersive three-dimensional visual field. The impressive hardware facilitates, for example, the dissection of the peri-prostatic fascia, whilst preserving the neurovascular bundle, or the suturing of the vesico-urethral anastomosis. Prior to RALP, Laparoscopic Radical Prostatectomy (LRP) represented the first venture into the minimally invasive world. Associated with more cumbersome ergonomics, LRP has a significant learning curve when compared with the robotic approach. There has been a paucity, until recently, of high-quality literature comparing outcomes between the two operations, including the attainment of the Pentafecta of survivorship: biochemical recurrence-free, continence, potency, no postoperative complications and negative surgical margins.