Grey ZoneRationale for Robotic-assisted Simple Prostatectomy for Benign Prostatic Obstruction
Section snippets
Surgical treatment of large prostate adenoma: current scenario
Surgical intervention is recommended in the setting of benign prostatic obstruction (BPO) refractory to medical therapy or associated with urinary retention, recurrent urinary tract infections, recurrent hematuria, impaired renal function secondary to obstructive uropathy, and bladder stones. In the specific case of large prostate glands, commonly defined as ≥80 ml, the European Association of Urology guidelines recommend open simple prostatectomy (OSP), holmium laser enucleation of the prostate
Evolution of RASP
RASP was first described by Sotelo et al in 2008 [7]. Since then, the procedure has gradually been implemented at several institutions worldwide [8]. Parallel to the clinical implementation of this procedure, there has also been a steady increase in the number of publications on RASP, especially over the past 5 yr (Fig. 1).
An abundance of RASP techniques has been described in the literature over the last decade, each featuring specific technical nuances (Table 1). The transperitoneal approach
Outcomes
Over 1200 RASP cases have been reported to date (Fig. 2), which testifies the fact that the procedure is safe and effective, and it has well passed the “investigational” stage. In the largest series to date [8], a multicenter study including 487 cases, median operative time was 154 min, median estimated blood loss was 200 ml, and median length of stay was 2 d. In terms of functional outcomes, median International Prostate Symptom Score declined from 23 to 7, median Qmax increased from 8 to 25
Why and when RASP can be an attractive option
The rationale behind the shift from open surgery to minimally invasive techniques for the surgical management of large-gland BPH is driven by the quest of obtaining comparable function outcomes with lower perioperative morbidity [1], [2]. While HoLEP has certainly stood the test of time by proving its clinical efficacy [3], it requires specific instrumentation, and its steep learning curve remains the main barrier to its implementation [4]. For this reason, there has been an interest in other
Grey areas
While representing an attractive option in general, some “grey” areas for RASP remain. The lack of a standardized technique can be regarded as a limitation, and therefore effort should be made to standardize the procedure to allow better reproducibility and teaching. Moreover, in absence of randomized trials, there is still a lack of level I evidence. While the few available comparative studies can partially obviate to this issue, more efforts should be made in this area of clinical research.
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Cited by (11)
Robotic-assisted simple prostatectomy versus holmium laser enucleation of the prostate for large benign prostatic hyperplasia: A single-center preliminary study in Korea
2022, Prostate InternationalCitation Excerpt :This complication was frequently reported in other studies. Autorino et al.14 in their comparative study reported bladder neck contracture in three out of 487 patients (0.6%) and three out of 843 patients (0.35%) in RASP and laparoscopic simple prostatectomy groups, respectively. On the other hand, Sorokin et al.25 reported bladder neck contracture in two and zero patients among OSP and RASP groups, respectively.
Management of prostate cancer after holmium laser enucleation of the prostate
2021, Urologic Oncology: Seminars and Original InvestigationsCitation Excerpt :Ten of the 12 patients undergoing HoLEP for BPH and CaP were treated with the intent to improve their LUTS and determine if this subtotal prostatectomy might be curative, and with relatively short oncologic outcomes, the patients are without evidence of disease. Clinical investigation of robotic subtotal prostatectomy is in progress, indicating that other investigators are pursuing similar approaches [26,27]. Ongoing surveillance will determine the risk of CaP developing in the remaining prostatic tissue.
Mid-term functional outcomes of extraperitoneal robot-assisted simple prostatectomy: a single centre experience
2022, Journal of Robotic Surgery
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These authors contributed equally.