Retropubic, Laparoscopic, or Robotic Radical Prostatectomy: Is There Any Real Difference?

The surgical management of localized prostate cancer has evolved over the last 20 years. The “gold standard” open radical prostatectomy (ORP) has been replaced largely by the robotic-assisted laparoscopic radical retropubic prostatectomy (RALP) as the most common surgical approach to treat localized prostate cancer. Pure laparoscopic radical prostatectomy (LRP), still performed by a limited number of surgeons, was more commonly utilized before the widespread availability of the robotically assisted technique. The general consensus based on the current literature is that RALP is associated with less blood loss and a shorter hospital stay but at a higher cost when compared to ORP. The literature continues to be conflicted concerning outcome measures such as impotence and urinary incontinence. Large series of long-term oncologic follow-up are not yet available; however, the data suggest that oncologic control is similar between RALP and ORP. Considerable disparities in measurement and reporting practices of perioperative outcomes continue to make direct comparisons difficult. Future prospective studies of perioperative outcomes should aim to use rigorous methodology and established criteria for standardized reporting.