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A selected review and personal experience with robotic prostatectomy: implications for adoption of this new technology in the United Kingdom

Prostate Cancer and Prostatic Diseases volume 10, pages 242–249 (2007)Cite this article

Abstract

Robot-assisted laparoscopic prostatectomy (RALP) is a rapidly evolving technique for the treatment of localized prostate cancer. However, cynics point to the increasing role of market forces in the robotic revolution. As yet, Europe has not taken up RALP in large numbers and this may in part relate to the high level of expertise in laparoscopy previously gained. Furthermore, setting up a robotic programme is a major undertaking for many surgical units. This review discusses some of the challenges in the development of a robotic service drawn from personal experience within the United Kingdom. Furthermore, available data on RALP versus open and laparoscopic approaches are reviewed for surgical and cancer-related outcomes. Preliminary data appear to show an advantage over open prostatectomy with reduced blood loss, decreased pain and early mobilisation and shorter hospital stay. Most intra-institutional studies demonstrate better postoperative continence and potency with RALP; however, this needs to be viewed in the context of a paucity of randomized data available in the literature. There is no definitive data to show an advantage over standard laparoscopic surgery, but the fact that this technique has reached parity with laparoscopy within 5 years is encouraging: with continued experience, the hope is that results will continue to improve.

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References

  1. Kaul S, Menon M . Robotic radical prostatectomy: evolution from conventional to VIP. World J Urol 2006; 24: 152–160.

    Article  Google Scholar 

  2. Smith Jr JA, Herrell D . Robotic-assisted laparoscopic prostatectomy: do minimally invasive approaches offer significant advantages? J Clin Oncol 2005; 23: 8170–8175.

    Article  Google Scholar 

  3. Guillonneau B, Abbou C, Doublet J, Gaston R, Janetschek G, Mandressi A et al. Proposal for a ‘European scoring system for laparoscopic operations in urology’. Eur Urol 2001; 40: 2–6.

    Article  CAS  Google Scholar 

  4. Ahlering T, Skarecky D, Lee D, Clayman R . Successful transfer of open surgical skills to a laparoscopic environment using a robot interface: initial experience with laparoscopic radical prostatectomy. J Urol 2003; 170: 1738–1741.

    Article  Google Scholar 

  5. Kwoh Y, Hou J, Jonckheere E, Hayati S . A robot with improved absolute positioning accuracy for CT sterotactic brain surgery. IEEE Trans Biomed Eng 1988; 35: 153–160.

    Article  CAS  Google Scholar 

  6. Davies B, Hibberd R, Ng W, Timoney A, Wickham J . The development of a surgeon robot for prostatectomies. Proc Inst Mech Eng 1991; 205: 35–38.

    Article  CAS  Google Scholar 

  7. Paul H, Bargar W, Mittlestadt B, Musits B, Taylor RH, Kazanzides P et al. Development of a surgical robot for cementless total hip arthroplasty. Clin Orthop 1992; 285: 57–66.

    Google Scholar 

  8. Guillonneau B . What robotics in urology? A current point of view. Eur Urol 2003; 43: 103–105.

    Article  Google Scholar 

  9. Kavoussi L, Moore R, Adams J, Partin A . Comparison of robotic versus laparoscopic camera control. J Urol 1995; 154: 2134–2136.

    Article  CAS  Google Scholar 

  10. Challacombe B, Patriciu A, Glass J, Aron M, Jarrett T, Kim F et al. A randomised controlled trial of human versus robotic and telerobotic access to the kidney as the first step in percutaneous nephrolithotomy. Comput Aided Surg 2005; 10: 165–171.

    Article  Google Scholar 

  11. Shah J . Robotic surgery. Cancer Topics 2006; 12: 14–16.

    Google Scholar 

  12. Binder J, Kramer W . Robotically assisted laparoscopic radical prostatectomy. BJU Int 2001; 87: 408–410.

    Article  CAS  Google Scholar 

  13. Pasticier G, Rietbergen J, Guillonneau B, Fromont G, Menon M, Vallancien G . Robotically assisted laparoscopic radical prostatectomy: feasibility study in men. Eur Urol 2001; 40: 70–74.

    Article  CAS  Google Scholar 

  14. Abbou C, Hoznek A, Salomon L, Olsson LE, Lobontiu A, Saint F et al. Laparoscopic radical prostatectomy with a remote controlled robot. J Urol 2001; 165: 1964–1966.

    Article  CAS  Google Scholar 

  15. Menon M, Tewari A, Peabody J, The VIP Team. Vattikuti Institute prostatectomy: technique. J Urol 2003; 169: 2289–2292.

    Article  Google Scholar 

  16. Sim H, Yip S, Lau W, Tan Y, Wong M, Cheng W . Team-based approach reduces learning curve in robot-assisted laparoscopic prostatectomy. Int J Urol 2006; 13: 560–564.

    Article  Google Scholar 

  17. Herrell S, Smith Jr J . Robotic-assisted laparoscopic prostatectomy: what is the learning curve? Urology 2005; 66 (Suppl 5A): 105–107.

    Article  Google Scholar 

  18. Walsh P, Donker P . Impotence following radical prostatectomy: insight into etiology and prevention. J Urol 1982; 128: 492–497.

    Article  CAS  Google Scholar 

  19. Guillonneau B, Vallancien G . Laparoscopic radical prostatectomy: the Montsouris technique. J Urol 2000; 163: 1643–1649.

    Article  CAS  Google Scholar 

  20. Rassweiler J, Sentker L, Seeman O, Hatzinger M, Stock C, Frede T . Heilbronn laparoscopic radical prostatectomy: technique and results after 100 cases. Eur Urol 2001; 40: 54–64.

    Article  CAS  Google Scholar 

  21. Joseph J, Rosenbaum R, Madeb R, Erturk E, Patel H . Robotic extraperitoneal radical prostatectomy: an alternative approach. J Urol 2006; 175 (3 Pt1): 945–950.

    Article  CAS  Google Scholar 

  22. Wolfram M, Brautigam R, Engl T, Bentas W, Heitkamp S, Ostwald M et al. Robotic-assisted laparoscopic radical prostatectomy: the Frankfurt technique. World J Urol 2003; 21: 128–132.

    Article  CAS  Google Scholar 

  23. Menon M, Hemal A, VIP team. Vattikuti Institute prostatectomy: a technique of robotic radical prostatectomy: experience in more than 1000 cases. J Endourol 2004; 18: 611.

    Article  Google Scholar 

  24. Atug F, Castle E, Woods M, Srivastav S, Thomas R, Davis R . Transperitoneal versus extraperitoneal robotic-assisted radical prostatectomy: is one better than the other? Urology 2006; 68: 1077–1081.

    Article  Google Scholar 

  25. Hemal A, Eun D, Tewari A, Menon M . Nuances in the optimum placement of ports in pelvic and upper urinary tract surgery using the da Vinci robot. Urol Clin North Am 2004; 31: 683–692.

    Article  Google Scholar 

  26. Khaira H, Bruyere F, O'Malley P, Peters J, Costello A . Does obesity influence the operative course or complications of robot-assisted laparoscopic prostatectomy. BJU Int 2006; 98: 1275–1278.

    Article  Google Scholar 

  27. Ahlering T, Eichel L, Edwards R, Skarecky D . Impact of obesity on clinical outcomes in robotic prostatectomy. Urology 2005; 65: 740–744.

    Article  Google Scholar 

  28. Stolzenburg J-U, Aedtner B, Olthoff D, Koenig F, Rebenalt R, Filos KS et al. Anaesthetic considerations for endoscopic extraperitoneal and laparoscopic transperitoneal radical prostatectomy. BJU Int 2006; 98: 508–513.

    Article  Google Scholar 

  29. Stolzenburg J, Anderson C, Rabenalt R, Do M, Ho K, Truss M . Endoscopic extraperitoneal radical prostatectomy in patients with prostate cancer and previous laparoscopic inguinal mesh placement for hernia repair. World J Urol 2005; 23: 295–299.

    Article  Google Scholar 

  30. Van Velthoven R, Ahlering T, Peltier A, Skarecky DW, Clayman VII RV . Technique for laparoscopic running urethrovesical anastamosis: the single knot method. Urology 2003; 61: 699–702.

    Article  Google Scholar 

  31. Costello A . Beyond marketing: the real value of robotic radical prostatectomy. BJU Int 2005; 96: 1–2.

    Article  Google Scholar 

  32. Hemal A, Bhandari A, Tewari A, Menon M . The window sign: an aid in laparoscopic and robotic prostatectomy. Int Urol Nephrol 2005; 37: 73–77.

    Article  Google Scholar 

  33. Ahlering T, Eichel L, Chou D, Skarecky D . Feasibility study for robotic radical prostatectomy cautery-free neurovascular bundle preservation. Urology 2005; 65: 994–997.

    Article  Google Scholar 

  34. Ong A, Su L, Varkarakis I, Inagaki T, Link RE, Bhayani SB et al. Nerve sparing radical prostatectomy: effects of hemostatic energy sources on the recovery of cavernous nerve function in a canine model. J Urol 2004; 172: 1318–1322.

    Article  Google Scholar 

  35. Smith Jr J, Herrell S . A Transition from Open to Robotic-Assisted Laparoscopic Prostatectomy: The Vanderbilt Experience, 1st edn, Chapter 16. Informa Healthcare, UK, 2007.

  36. Myers R, Cahill D, Kay P, Camp JJ, Devine RM, King BF et al. Puboperineales: muscular boundaries of the male urogenital hiatus in 3D from magnetic resonance imaging. J Urol 2000; 164: 1412–1415.

    Article  CAS  Google Scholar 

  37. Steiner M . The puboprostatic ligament and the male urethral suspensory mechanism: an anatomic study. Urology 1994; 44: 530–534.

    Article  CAS  Google Scholar 

  38. Hemal A, Wadhwa S . Repair of the suspensory ligament of the penis: an important step in the transpubic approach. Br J Urol 1994; 74: 516.

    Article  CAS  Google Scholar 

  39. Menon M, Hemal A, Tewari A, Shrivastava A, Bhandari A . The technique of apical dissection of the prostate and urethrovesical anastamosis in robotic radical prostatectomy. BJU Int 2004; 93: 715–719.

    Article  CAS  Google Scholar 

  40. Deliveliotis C, Protogerou V, Alargof E, Varkarakis J . Radical prostatectomy. Bladderneck preservation and puboprostatic ligament sparing – effects on continence and positive margins. Urology 2002; 60: 855–888.

    Article  CAS  Google Scholar 

  41. Kitagawa M, Dokko D, Okamura A, Yuh D . Effect of sensory substitution on suture-manipulation forces for robotic surgical systems. J Thorac Cardiovasc Surg 2005; 129: 151–158.

    Article  Google Scholar 

  42. Scales C, Jones P, Eisenstein E, Preminger G, Albala D . Local cost structures and the economics of robot assisted radical prostatectomy. J Urol 2005; 174: 2323–2329.

    Article  Google Scholar 

  43. Dasgupta P, Challacombe B, Murphy D, Khan M . Coming full circle in robotic urology. BJU Int 2006; 98: 4–5.

    Article  Google Scholar 

  44. Badani K, Bhandari A, Tewari A, Menon M . Comparison of two-dimensional and three-dimensional suturing: is there a difference in a robotic surgery setting? J Endourol 2005; 19: 1212–1215.

    Article  Google Scholar 

  45. Menon M, Tewari A, Baize B, Guillonneau B, Vallancien G . Prospective comparison of radical retropubic prostatectomy and robot-assisted anatomic prostatectomy: the Vattikuti Urology Institute experience. Urology 2002; 60: 864–868.

    Article  Google Scholar 

  46. Farnham S, Webster T, Herrell S, Smith Jr JA . Intraoperative blood loss and transfusion requirement for robotic assisted laparoscopic prostatectomy versus radical prostatectomy. Urology 2006; 67: 360–363.

    Article  Google Scholar 

  47. Menon M . Robotic radical retropubic prostatectomy. BJU Int 2003; 91: 175–176.

    Article  CAS  Google Scholar 

  48. Costello A, Haxhimolla H, Crowe H, Peters J . Installation of telerobotic surgery and initial experience with telerobotic radical prostatectomy. BJU Int 2005; 96: 34–38.

    Article  Google Scholar 

  49. Herrell S, Smith J . Laparoscopic and robotic radical prostatectomy: what are the real advantages? BJU Int 2005; 95: 3–9.

    Article  Google Scholar 

  50. Joseph J, Vicente I, Madeb R, Erturk E, Patel H . Robot-assisted vs pure laparoscopic radical prostatectomy: are there any differences? BJU Int 2005; 96: 39–42.

    Article  Google Scholar 

  51. National Institute for Clinical Excellence (NICE) committee. Laparoscopic radical prostatectomy. 1-2. 1 November 2006.

  52. Ahlering T, Eichel L, Edwards R, Lee D, Starecky D . Robotic radical prostatectomy: a technique to reduce pT2 positive margins. Urology 2004; 64: 1224–1228.

    Article  Google Scholar 

  53. Basillotte J, Ahlering T, Starecky D, Lee DI, Clayman RV . Laparoscopic radical prostatectomy: review and assessment of an emerging technique. Surg Endosc 2004; 18: 1694–1711.

    Article  Google Scholar 

  54. Ahlering T, Eichel L, Skarecky D . Early potency with cautery-free neurovascular bundle preservation with robotic laparoscopic radical prostatectomy. J Endourol 2005; 19: 715–718.

    Article  Google Scholar 

  55. Chien G, Mikhail A, Orvieto M, Zagaja GP, Sokoloff MH, Brendler CB et al. Modified clipless antegrade nerve preservation in robotic-assisted laparoscopic radical prostatectomy with validated sexual function evaluation. Urology 2005; 66: 423.

    Article  Google Scholar 

  56. Litwin M, Melmed G, Nakazon T . Life after radical prostatectomy: a longitudinal study. J Urol 2001; 166: 592.

    Article  Google Scholar 

  57. Menon M, Kaul S, Bhandari A, Shrivastava A, Tewari A, Hemal A . Potency following robotic prostatectomy: a questionnaire based analysis of outcomes after conventional nerve sparing and prostatic fascia sparing techniques. J Urol 2005; 174: 2291–2296.

    Article  Google Scholar 

  58. Kaul S, Savera A, Badani K, Fumo M, Bhamdari A, Menon M . Functional outcomes and oncological efficacy of Vattikuti Insitute prostatectomy and Veil of Aphrodite nerve-sparing: an analysis of 154 consecutive patients. BJU Int 2006; 97: 467–472.

    Article  Google Scholar 

  59. Catalona W, Carvalhal G, Mager D, Smith D . Potency, incontinence and complication rates in 1,870 consecutive radical retropubic prostatectomies. J Urol 1999; 162: 433–438.

    Article  CAS  Google Scholar 

  60. Walsh P . Anatomic radical prostatectomy: evolution of the surgical technique. J Urol 1998; 160: 2418–2424.

    Article  CAS  Google Scholar 

  61. Menon M, Shrivastava A, Sarle R, Hemal A, Tewari A . Vattikuti institute prostatectomy. A single-team experience of 100 cases. J Endourol 2003; 17: 785–790.

    Article  Google Scholar 

  62. Tewari A, Srivastava S, Menon M, Members of VIP Team. A prospective comparison of radical retropubic and robot-assisted prostatectomy: experience in one institution. BJU Int 2003; 92: 205–210.

    Article  CAS  Google Scholar 

  63. Hsu E, Hong E, Lepor H . Influence of body weight and prostate volume on intraoperative, perioperative, and postoperative outcomes after radical retropubic prostatectomy. Urology 2003; 61: 601–606.

    Article  Google Scholar 

  64. Monk T, Goodnough L, Birkmeyer J, Brecher ME, Catalona WJ . Acute normovolaemic hemodilution is a cost-effective alternative to preoperative autologous blood donation by patients undergoing radical retropubic prostatectomy. Transfusion 1995; 35: 559–565.

    Article  CAS  Google Scholar 

  65. Guillonneau B, el-Fettouh H, Baumert H, Cathelineau X, Doublet JD, Fromont G et al. Laparoscopic radical prostatectomy: oncological evaluation after 1000 cases at Montsouris Institute. J Urol 2003; 169: 1266.

    Google Scholar 

  66. Guillonneau B, Rozet F, Cathelineau X, Lay F, Barret E, Doublet JD et al. Perioperative complications of laparoscopic radical prostatectomy: the Montsouris 3-year experience. J Urol 2002; 167: 51–56.

    Article  Google Scholar 

  67. Guillonneau B, Cathelineau X, Doublet J, Baumert H, Vallancien G . Laparoscopic radical prostatectomy: assessment after 550 procedures. Crit Rev Oncol Hematol 2003; 43: 123–133.

    Article  Google Scholar 

  68. Rassweiler J, Sentker L, Seeman O, Hatzinger M, Rumpelt HJ . Laparoscopic radical prostatectomy with the Heilbron technique: an analysis of the first 180 cases. J Urol 2001; 166: 2101–2108.

    Article  CAS  Google Scholar 

  69. Rassweiler J, Seemann O, Schulze M, Frede T . Laparoscopic versus open radical prostatectomy: a comparison study at a single institution. J Urol 2003; 169: 1689–1693.

    Article  Google Scholar 

  70. Abbou C, Salomon L, Hoznek A, Antiphon P, Cicco A, Saint F et al. Laparoscopic radical prostatectomy: preliminary results. Urology 2000; 55: 630–634.

    Article  CAS  Google Scholar 

  71. Jacob F, Salomon L, Hoznek A, Bellot J, Antiphon P, Chopin DK et al. Laparoscopic radical prostatectomy: preliminary results. Eur Urol 2000; 37: 615–620.

    Article  CAS  Google Scholar 

  72. Hoznek A, Salomon L, Olsson L, Antiphon P, Saint F, Cicco A et al. Laparoscopic radical prostatectomy: the Creteil experience. Eur Urol 2001; 40: 38–45.

    Article  CAS  Google Scholar 

  73. Anastasiadis A, Salomon L, Katz R, Hoznek A, Chopin D, Abbou CC . Radical retropubic versus laparoscopic prostatectomy: a prospective comparison of functional outcome. Urology 2003; 62: 292–297.

    Article  Google Scholar 

  74. Stolzenburg J-U, Rabenalt R, Do M, Ho K, Dorschner W, Waldkirch E et al. Endoscopic extraperitoneal radical prostatectomy: oncological and functional results after 700 procedures. J Urol 2005; 174: 1271–1275.

    Article  Google Scholar 

  75. Fabrizio M, Tuerk I, Schellhammer P . Laparoscopic radical prostatectomy: decreasing the learning curve using a mentor initiated approach. J Urol 2003; 169: 1063–2065.

    Article  Google Scholar 

  76. Menon M, Shrivastava A, Tewari A, Sarle R, Hemal A, Peabody J et al. Laparoscopic and robot assisted radical prostatectomy: establishment of a structured program and preliminary analysis of outcomes. J Urol 2002; 168: 945–949.

    Article  Google Scholar 

  77. Patel V, Tully A, Holmes R, Lindsay J . Robotic radical prostatectomy in the community setting – the learning curve and beyond: initial 200 cases. J Urol 2005; 174: 269–272.

    Article  Google Scholar 

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  1. Department of Urology, The Royal Marsden Hospital, London, UK

    M A Goldstraw

  2. The Prostate Centre, London, UK

    M A Goldstraw, K Patil, C Anderson, P Dasgupta & R S Kirby

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Goldstraw, M., Patil, K., Anderson, C. et al. A selected review and personal experience with robotic prostatectomy: implications for adoption of this new technology in the United Kingdom. Prostate Cancer Prostatic Dis 10, 242–249 (2007). https://doi.org/10.1038/sj.pcan.4500968

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