Prostate cancer (PCa) is still the second leading cause of cancer-related death in men in the United States. Most of the PCa are organ confined at the time of diagnosis. To watch (observation / active surveillance) or fry (radiotherapy) or poke (HIFU / cryo) or remove (surgery) is a big topic of debate. In this review we will analyse the status of robotic surgery if a patient and his surgeon decides on radical prostatectomy (RP). Has it reached gold standard? In 2001, less than 0.3% of all RPs were performed robotically; however, by 2011, 61-80% of all RPs in the United States were being performed with robotic assistance. Robotic assisted RPs offer excellent and lasting oncologic control, which is at least equivalent to that achieved with an open RP. Technical refinements in apical dissection, such as the retroapical approach of synchronous urethral transection, and adoption of real-time frozen section analysis of the excised prostate during robotic assisted RPs, have further substantially reduced positive surgical margin rates, particularly in high-risk disease patients. Few modifications, like usage of barbed sutures and suprapubic catheters, did not improve the functional outcomes and made only minor impact. Furthermore, precision offered by the robotic platform and technical evolution of RPs, including enhanced nerve sparing, athermal dissection and reduced nerve traction have led to improved potency and continence outcomes as well as a better safety profile in patients undergoing surgical therapy for PCa.

Robot-assisted radical prostatectomy: inching toward gold standard.
Sood A, Jeong W, Peabody JO, et al.
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Ananda Kumar Dhanasekaran

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