Minimally invasive techniques, such as Laparoscopic Radical Prostatectomy (LRP) and Robot-Assisted Radical Prostatectomy (RARP), have demonstrated several advantages over open surgery, including reduced blood loss, shorter hospital stays, and lower morbidity and mortality. While both techniques have shown benefits in terms of continence and potency compared to the open approach, whether one minimally invasive technique outperforms the other remains a topic of debate.
Some studies suggest that RARP, likely due to its enhanced visualization, precision, and improved control over neurovascular bundles and the urethra, may offer better functional outcomes than LRP. The recent LAP-01 trial investigated this hypothesis, and our study sought to validate these findings in our own cohort: is RARP truly superior to LRP?
In this study, we confirmed the superiority of RARP over LRP, particularly regarding functional outcomes like urinary continence and sexual potency, at both short- and mid-term follow-up. Our findings align with the LAP-01 trial, further supporting the robotic approach's advantages. Specifically, RARP showed a significant advantage in continence recovery, with higher and faster continence rates compared to LRP. The benefits in terms of potency were even more pronounced, especially among patients undergoing bilateral nerve-sparing procedures.
A unique aspect of our study is the external validation conducted in a single-surgeon, single-centre cohort, ensuring consistency and minimizing variability. We employed standardized data collection methods, such as the PAD24h test, which adds to the robustness of our findings. Furthermore, we performed a subanalysis examining the influence of the learning curve on surgical outcomes. Interestingly, even during the initial phase of the surgeon's robotic experience, RARP continued to demonstrate superior functional outcomes, suggesting that the learning curve does not significantly compromise the benefits of the robotic approach.
While the retrospective nature of our study is a limitation, our results have important implications for clinical decision-making in prostate cancer treatment. RARP offers clear advantages in terms of recovery, particularly for urinary continence and sexual function. Future studies, including those with longer follow-up periods and multicentre data, are necessary to further validate the long-term durability of these outcomes and to ensure that the robotic approach maintains its superiority over time.
Written by: Alicia López-Abad1 and Miguel Ramirez Backhaus2
- Department of Urology. Virgen de la Arrixaca University Hospital, Murcia, Spain
- Director of Urosalud Clinic, Valencia, Spain
- International Agency for Research on Cancer, World health organization. Globocan [Internet]. [cited 2023 May 21]. 2022
- N. Mottet, P. Cornford, R. van den Bergh, E. Briers, Expert Patient Advocate (European Prostate Cancer Coalition/Europa Uomo), D. Eberli, et al., EAU - EANM - ESTRO ESUR - ISUP - SIOG Guidelines on Prostate Cancer 2023 [Internet], European Association of Urology, 2023 [cited 2023 Jul 31]. Available from: https: //uroweb.org/guidelines/prostate-cancer.
- J.U. Stolzenburg, S. Holze, P. Neuhaus, I. Kyriazis, H.M. Do, A. Dietel, et al., Robotic-assisted versus laparoscopic surgery: outcomes from the first multicentre, randomised, patient-blinded controlled trial in radical prostatectomy (LAP-01), Eur. Urol.
- C. Allan, D. Ilic, Laparoscopic versus robotic-assisted radical prostatectomy for the treatment of localised prostate cancer: a systematic review, Urol. Int. 96 (4) (2016) 373–378.
This webpage is supported through an unrestricted educational grant from Bayer. Bayer is not involved in content development and the views expressed represent those of the patient and physician contributors.
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