Has laparoscopic radical prostatectomy had its day?
Reviewed by Kate Linton

Over recent years there has been a massive uptake in robotic surgery particularly for robot-assisted prostatectomy. The drive for this has been patient and physician led with little in the way of prospective randomised trials showing benefits over established operative techniques. Porpiglia et al. have performed a randomised study of robot-assisted radical prostatectomy (RARP) versus laparoscopic radical prostatectomy (LRP). All procedures were performed by one surgeon who had performed more than 600 laparoscopic and 100 robotic prostatectomies. One hundred and twenty men with T1-T2 disease and no previous prostate cancer treatment or transurethral resection of the prostate (TURP) were randomised, 60 in each group. The primary outcome measure was continence at three months, with secondary endpoints including continence at different endpoints, perioperative results, rates of positive surgical margins and recovery of erectile function. Perioperative complication rates were similar for the two groups. Continence rates were improved in the RARP group - 80% compared with 61.6% in the LRP group at three months. RARP was associated with improved continence at all time points, from catheter removal to 12 months post surgery. Erectile function was improved in the RARP group - at one year 80% were potent in the nerve sparing group compared with 54.2% in the LRP group. There was no statistical difference in positive surgical margins between the two groups and no differences in prostate specific antigen (PSA) results between the two groups. The follow-up of this study was too short to allow oncological outcomes to be assessed. Although this is a small study and the results of only one surgeon’s surgical practice, RARP does appear to be associated with improved functional outcomes. Only time will tell whether RARP truly is better than LRP, when we have long-term oncological data to support it from prospective randomised trials.

Randomised controlled trial comparing laparoscopic and robot-assisted radical prostatectomy.
Porpiglia F, Morra I, Chiarissi ML, et al.
EUROPEAN UROLOGY
2013;63:606-14.