Radical Prostatectomy in the Robotic Era. Comparison of Three Different Methods: Retropubic, Robotic and Perineal

Abstract

Prostate cancer is the second most prevalent cancer among men and is the 6th cancer type leading to death. Starting with the use of PSA screening, there has been a steep increase in the number of cases diagnosed with and treated for localized prostate cancer. Radical prostatectomy use has increased following the increase in the number of cases and has become the golden standard for surgical procedures for their treatment. For over 50 years, while open retropubic and perineal methods have been used separately, advantages and disadvantages of each method have been expressed in official and unofficial grounds. The use of nerve-sparing radical prostatectomy that began particularly after the clearer definition of the neurovascular bundles and the anatomy of the prostate by Walsh and the improvements in continence and potency has proved open radical retropubic prostatectomy (RRP) more advantageous. The da Vinci Surgical System (Intuitive Surgical, Sunnyvale, CA, USA), developed to qualify disadvantages of laparoscopy in radical prostatectomy, came into use in 2000. With Abbou's identification of first robotic assisted radical prostatectomy (RARP), it finds increasing areas of application. Still there is need for further comparison of especially the three methods (RPP, RRP, and RARP) in prostate cancer treatment with more patients and longer follow-up periods. The objective of the first part of this paper is to provide a brief comparison of RRP and RARP results and in the second part we will discuss the perineal radical prostatectomy.