Review: Evolution of Minimally Invasive Radical Prostatectomy – A Continuous Development

*Karol Axcrona,1 Viktor Berge2

1. Department of Urology, The Norwegian Radium Hospital, Oslo University Hospital, Oslo, Norway
2. Department of Urology, Aker University Hospital, Oslo University Hospital, Oslo, Norway
*Correspondence to axcrona@online.no

Disclosure: No potential conflict of interest

Abstract

During the last 15 years, minimally invasive surgery has been introduced gradually in surgical treatment for prostate cancer (CaP). Laparoscopic radical prostatectomy (LRP) was introduced in the late 1990s but never gained widespread acceptance because of the steep learning curve of the technique. However, LRP is still a thriving technique in multiple centres in Europe and in other regions outside the United States. During previous years, LRP has been overshadowed by robot-assisted laparoscopic radical prostatectomy (RALP), which was first reported in 2001. Its use increased dramatically, and in 2008, >75% of all radical surgical procedures for CaP were performed by RALP in the United States. Modifications of the minimally invasive operative technique and gained knowledge of the surgical anatomy have been applied in CaP surgery during the last decade. In addition, technical development of the robotic device with improved vision, and the introduction of new instruments have occurred. Growing concerns about costs in conjunction with surgical treatment for CaP have arisen during recent years. Introduction of LRP and RALP seem to be accompanied by higher costs for healthcare systems. As results regarding oncological and functional outcome have not definitely been proven to be improved with the introduction of new technology, minimal invasive surgery has been questioned, and opposed to traditional (open) retropubic prostatectomy. This review aims at giving a background for the introduction of minimally invasive surgery for CaP treatment.

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