[Robot assisted radical prostatectomy: What are the evidences at the time of a specific funding?]

Despite a decreasing number of radical prostatectomies in France, the number of robot-assisted surgeries increases. The objective of this work is to assess the interest of robotic prostatectomy before asking a specific funding from health authorities.

A systematic review of the literature on PubMed was performed. Prospective studies and meta-analyses comparing robot-assisted radical prostatectomy (RARP), laparoscopic (LRP) and open surgery (OP) were selected.

There are only two randomized clinical trials comparing RARP and LRP. Erectile function was significantly better after RARP than after LRP. Compared to OP, sexuality evaluation, based on meta-analyses, was significantly better at 12 months and the absolute risk of erectile dysfunction significantly decreased. Continence after RARP was significantly better than LRP 3 months after surgery. Compared to OP, continence results were discordant, sometimes significantly in favor of RARP, sometimes similar. The rate of positive margins was similar whatever the technique. The long-term oncological outcomes were similar. In terms of perioperative complications, no significant difference was observed between RARP and LRP or OP.

RARP provides same oncological outcomes as the open and laparoscopic approach. Continence and sexuality are better after RARP than after laparoscopic or open surgery. However, no randomized study comparing RARP and OP is available.

Progres en urologie : journal de l'Association francaise d'urologie et de la Societe francaise d'urologie. 2017 Feb 03 [Epub ahead of print]

J-A Long, G Poinas, G Fiard, M Leprêtre, C Delaitre-Bonnin, X Rébillard, J-L Descotes

Service d'urologie, CHU de Grenoble, 38043 Grenoble cedex 9, France; TIMC-IMAG, CNRS 5525, domaine de la Merci, 38700 La Tronche, France. Electronic address: ., Clinique Beau Soleil, Montpellier, France., Service d'urologie, CHU de Grenoble, 38043 Grenoble cedex 9, France; TIMC-IMAG, CNRS 5525, domaine de la Merci, 38700 La Tronche, France., Mapigroup, Lyon, France., Clinique Beau Soleil, Montpellier, France; Association française d'urologie (AFU), Paris, France., Service d'urologie, CHU de Grenoble, 38043 Grenoble cedex 9, France; TIMC-IMAG, CNRS 5525, domaine de la Merci, 38700 La Tronche, France; Association française d'urologie (AFU), Paris, France.

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