Best Practices in Robot-assisted Radical Prostatectomy: Recommendations of the Pasadena Consensus Panel

Description of the Open Anterograde Anatomic Radical Retropubic Prostatectomy Technique

“…The refinement of surgical technique and the incorporation of new technologies such as robotics have contributed to better oncological and functional outcomes, as well as leading to the classification of this procedure as minimally invasive surgery [1,2]. The laparoscopic prostatectomy technique was first developed in 1997 by Shuessler et al [3] and improved over time.…”

“…RARP has become the leading surgical technique in the United States, and its adoption is also expanding in other countries. Several systematic reviews and randomized controlled clinical trials have indicated that RARP and LRP are advantageous for the preservation of continence and recovery of potency, despite the absence of high-quality randomized controlled prospective trials supporting their superiority over open radical retropubic prostatectomy (RRP) and the significant disparity between video-assisted anterograde technique (laparoscopic or robotic) and the open retrograde Walsh RRP [2,5,6]. Furthermore, the high cost of robotic surgery has limited its use in developing countries such as Brazil, where the incidence of prostate cancer was estimated at 61,200 new cases in 2016, with an overall risk of 61.82 per 100,000 men [5,7].…”

“…Laparoscopic radical prostatectomy (LRP) and robot-assisted radical prostatectomy (RARP) are currently well-established procedures and have been adopted at major urological centers worldwide. Both methods were discussed in detail by the Pasadena Consensus Panel in 2012 [2]. RARP has become the leading surgical technique in the United States, and its adoption is also expanding in other countries.…”

Modelo de programa de treinamento em cirurgia robótica e resultados iniciais

“…The main criticism of this new access route is still the high cost per procedure. In first world countries the surgeries by robot and the number of implanted systems grow at a fast pace [3][4][5] . Normally, during training, surgeons are tutored for a short time and in few cases, which increases the learning curve and leads to questionable results in terms of complications and morbidity 6 .…”

“…In the first years of the robotic access route, prostate surgery was the most cost-effective 4 . With the passage of years and dilution of implantation costs, other procedures are beginning to prove adequate: operations in super obese individuals, esophageal procedures, low rectal resections, enlarged hysterectomies with pelvic lymphadenectomy, surgery to treat endometriosis and others.…”