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Robot-Assisted Radical Prostatectomy

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Minimally Invasive Urology

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Abstract

In the field of oncologic urologic surgery, robot-assisted radical prostatectomy (RARP) represents the main application of the robotic approach. RARP is currently the leading urologic use of the da Vinci system, and more than 80 % of the radical prostatectomies performed in the USA in 2011 were carried out by robot-assisted surgery. Indications for RARP are the same with those for radical retropubic prostatectomy (RRP), and RARP has also been described as a salvage surgical treatment after radiotherapy (RT), brachytherapy, and high-intensity focused ultrasound. Under an oncological point of view, RARP offers at least the same results of RRP also in higher-risk patients. Extended lymph node dissection yielding a reasonably high number of lymph nodes is feasible during RARP. The mean complication rate of RARP is 9 % (range, 3–26 %). Twelve-month urinary incontinence rates after RARP range from 4 to 31 %, with significant advantage in favor of RARP in comparison with RRP and laparoscopic radical prostatectomy. RARP is associated with an incidence of 12- and 24-month erectile dysfunction ranging from 10 to 46 % and from 6 to 37 %, respectively. A significant advantage in favor of RARP in comparison with RRP in terms of 12 months’ potency rates has been observed. Concomitant good oncological, continence, and potency outcomes define the concept of “trifecta.”

This chapter presents the technique for RARP described by Patel, which introduces some differences from the standard laparoscopic and robotic technique described previously.

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Authors and Affiliations

  1. Department of Urology, Clinica Urologica I., Fondazione IRCCS Ca’ Granda – Ospedale Maggiore Policlinico, Via Commenda, 15, 20122, Milan, Italy

    Bernardo Rocco MD

  2. Department of Urology, University of Central Florida School of Medicine, Orlando, FL, USA

    Rafael Ferreira Coelho MD

  3. Department of Urology, Hospital Israelita Albert Einstein, Sao Paulo, SP, Brazil

    Rafael Ferreira Coelho MD

  4. Department of Urology, Instituto do Câncer do Estado de São Paulo, Sao Paulo, SP, Brazil

    Rafael Ferreira Coelho MD

  5. Department of Urology, Global Robotics Institute, Florida Hospital Celebration Health, Celebration, FL, USA

    Rafael Ferreira Coelho MD

  6. Università degli Studi di Milano, Clinica Urologica I. Fondazione IRCCS Ca’ Granda - Ospedale Maggiore Policlinico, Via Commenda, 15, 20122, Milan, Italy

    Gabriele Cozzi MD & Elisa De Lorenzis MD

  7. Department of Urology, Global Robotics Institute, Florida Hospital, Celebration Health, 410 Celebration Place Suite 200, Celebration, FL, 34747, USA

    Vipul Patel MD

  8. University of Central Florida School of Medicine, Orlando, FL, USA

    Vipul Patel MD

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  1. Bernardo Rocco MD
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  2. Rafael Ferreira Coelho MD
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  3. Gabriele Cozzi MD
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  4. Elisa De Lorenzis MD
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  5. Vipul Patel MD
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Correspondence to Vipul Patel MD .

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Editors and Affiliations

  1. Department of Urology, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA

    Sara L. Best

  2. Department of Urology, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA

    Stephen Y. Nakada

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Rocco, B., Coelho, R.F., Cozzi, G., De Lorenzis, E., Patel, V. (2015). Robot-Assisted Radical Prostatectomy. In: Best, S., Nakada, S. (eds) Minimally Invasive Urology. Springer, New York, NY. https://doi.org/10.1007/978-1-4939-1317-6_5

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