Robot-Assisted Radical Prostatectomy

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.