Point: Open Radical Prostatectomy Should Not Be Abandoned

Robotic-assisted laparoscopic radical prostatectomy is now one of the most common ways to treat prostate cancer. Although it is undoubtedly an outstanding procedure, in many contexts the advantages of the laparoscopic approach are overstated. The authors believe that open radical prostatectomy will continue to have an important role. For example, an extensive lymphadenectomy is more easily accomplished with the open technique and may be important in staging and possibly curing patients at high risk for prostate cancer. Also, tactile sensation is a valuable asset in assessing the extent of local tumor, and this cannot yet be replicated with a robotic approach. Furthermore, obese patients, those with a history of extensive prior surgical procedures, and men with extremely large prostates may experience advantages with the open technique. Finally, the open approach has a significant advantage in terms of hospital costs.

If the inline PDF is not rendering correctly, you can download the PDF file here.

Correspondence: William J. Ellis, MD, Department of Urology, Washington University, Box 356510, Seattle, WA 98195. E-mail: wjellis@u.washington.edu

References

  • 1.

    MarshallFFChanDPartinAW. Minilaparotomy radical retropubic prostatectomy: technique and results. J Urol1998;160:24402445.

  • 2.

    NelsonBKaufmanMBroughtonG. Comparison of length of stay between radical retropubic prostatectomy and robotic assisted laparoscopic prostatectomy. J Urol2007;177:929931.

    • Search Google Scholar
    • Export Citation
  • 3.

    FarnhamSBWebsterTMHerrellSDSmithJA. Intraoperative blood loss and transfusion requirements for robotic assisted radical prostatectomy versus radical retropubic prostatectomy. Urology2006;67:360363.

    • Search Google Scholar
    • Export Citation
  • 4.

    BeggCBRiedelERBachPB. Variations in morbidity after radical prostatectomy. N Engl J Med2002;1:11381144.

  • 5.

    MenonMTewariAPeabodyJ. Vittakuti Institute prostatectomy: technique. J Urol2003;169:22892292.

  • 6.

    PatelRLeporH. Removal of urinary catheter on postoperative day 2 or 4 after radical retropubic prostatectomy. Urology2003;61:156160.

    • Search Google Scholar
    • Export Citation
  • 7.

    WarnckeSHMatteiAFuechselFG. Detection rate and operating time required for gamma probe–guided sentinel lymph node resection after injection of technetium-99m nanocolloid into the prostate with and without preoperative imaging. Eur Urol2007;52:126132.

    • Search Google Scholar
    • Export Citation
  • 8.

    SimHGKliotMLangePH. Two-year outcome of unilateral sural nerve interposition graft after radical prostatectomy. Urology200;68:12901294.

    • Search Google Scholar
    • Export Citation
  • 9.

    LotanYCadedduJAGettmanMT. The new economics of radical prostatectomy: cost comparison of open, laparoscopic, and robot assisted techniques. J Urol2004;172:14311435.

    • Search Google Scholar
    • Export Citation
  • 10.

    ScalesCDJonesPJEisensteinEL. Local cost structures and the economics of robot assisted radical prostatectomy. J Urol2005;174:23232329.

    • Search Google Scholar
    • Export Citation
  • 11.

    McConnellJDClaymanRVFlaniganRC. The future of urology and urologic education in America. American Board of Urology newsletter. Available at: http://www.auanet.org/about/futureuroed.pdf. Accessed 13 July 2007.

    • Search Google Scholar
    • Export Citation
  • 12.

    AhleringTESkareckyDLeeDClaymanRV. Succesful transfer of open surgical skills to a laparoscopic environment using a robotic interface: initial experience with laparoscopic radical prostatectomy. J Urol2003;170:17381741.

    • Search Google Scholar
    • Export Citation
  • 13.

    HerrellSDSmithJA. Robotic-assisted laparoscopic prostatectomy: what is the learning curve?Urology2005;66(5 suppl):105107.

Article Information

PubMed

Google Scholar

Related Articles

Metrics

All Time Past Year Past 30 Days
Abstract Views 0 0 0
Full Text Views 44 44 19
PDF Downloads 20 20 3
EPUB Downloads 0 0 0