Robotic‐assisted laparoscopic prostatectomy: An update on functional and oncologic outcomes, techniques, and advancements in technology

Abstract

The robotic platform has revolutionized the management of prostate cancer over the last 15 years. Several techniques have been developed to improve functional and oncologic outcomes, including meticulous apical and posterior dissection, nerve sparing techniques, bladder neck and urethral length sparing, and anastomotic reconstruction. Future developments involving novel single-site, robotic technology will undoubtedly further the field of minimally invasive urology. These topics are reviewed within this article.

Robotics in urology

“…Other technical adjustments have included bladder neck preservation, periurethral suspension and reconstruction, preservation of urethral length, puboprostatic ligaments and endopelvic fasica -all of which have been greatly facilitated by the robotic system. 13 Despite probably the fastest-growing and evolving robotic procedure, level 1 evidence comparing RALP with its counterparts has been limited. Asimakopoulos et al reported the first randomised control trial (RCT) comparing LRP and RALP.…”

Urological technology: where will we be in 20 years’ time?

“…In an effort towards complete tumour removal without incision and scattering, novel procedures may include a robotic en bloc resection for nonmuscle invasive transitional cell carcinoma, as well as a robotic radical prostatectomy with a perineal approach. [28][29][30] In addition, future advances in robotics such as the Telelap ALF-X (Intuitive Surgical Inc.) improve upon the artificial da Vinci surgical environment by increasing situational awareness of surgeons through the use of 3D glasses, as opposed to enveloping the surgeon's face, whilst also providing haptic feedback technology. 31 Robotics is likely to become available to all patient cohorts, contributed in part by the expiration of a number of intellectual property patents, and thus a reduction in costs.…”

“…Despite obvious challenges due to the smaller and more complex anatomy, technical manoeuvres, such as decompression of the bladder, can be learnt to overcome these obstacles. 33 The future of robotic urological surgery is exciting and will improve postoperative outcomes and patient satisfaction 28 However, it demands greater complexity in terms of structural needs, staff and technology, and therefore must be constantly scrutinized. 34 In addition, robotic surgery has not been proven to be better than laparoscopic surgery in many procedures such as radical nephrectomy, indicating that more improvements still need to be made, particularly in a healthcare system with limited resources.…”

Ocular blood flow in steep Trendelenburg positioning during robotic-assisted radical prostatectomy

“…also requires the steep Trendelenburg position (30°-45°) (3). Robotic and nonrobotic assisted laparoscopic prostatectomy have a significant impact on both the heart and circulatory system.…”