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SYMPOSIUM EDITORIAL
Year : 2014  |  Volume : 30  |  Issue : 4  |  Page : 398
 

Current concepts in robotic radical prostatectomy


Chairman, Academic and Research, Department of Urology, Medanta Kidney and Urology Institute, Medanta - The Medicity, Gurgaon, Haryana, India

Date of Web Publication1-Oct-2014

Correspondence Address:
Narmada P Gupta
Chairman, Academic and Research, Department of Urology, Medanta Kidney and Urology Institute, Medanta - The Medicity, Gurgaon, Haryana
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0970-1591.142061

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How to cite this article:
Gupta NP. Current concepts in robotic radical prostatectomy . Indian J Urol 2014;30:398

How to cite this URL:
Gupta NP. Current concepts in robotic radical prostatectomy . Indian J Urol [serial online] 2014 [cited 2019 Sep 22];30:398. Available from: http://www.indianjurol.com/text.asp?2014/30/4/398/142061


The pioneering contributions of Dr Patrick Walsh on the anatomic dissection for preservation of the neurovascular bundles (NVBs) remain one of the most significant landmarks in urological history. He also described "Anatomical Radical Prostatectomy" on the basis of the venous drainage, arterial and nerve supply and fascial relations of the prostate. As a result, radical prostatectomy (RP) has become the treatment of choice for patients with clinically localized prostate cancer and life expectancy of more than 10 years. With the development of minimally invasive surgery came laparoscopic radical prostatectomy (LRP) in 1994 and robotic-assisted laparoscopic radical prostatectomy (RALP) in 2000. Because of the technical difficulties and a steep learning curve, LRP did not become popular. The dexterity of the robot facilitated complex reconstruction deep in the pelvis, reproducing and often surpassing open surgical techniques. The feasibility and safety of the procedure has been well documented. However, techniques continue to be refined to improve functional and oncological outcomes. Today, in the US, more than 80% of RPs are performed robotically. Whether this is media and marketing hype or truly better outcomes will be decided in the future. Whatever be the technology, it is the surgeon's skill and experience that determine outcomes.

In India, the scenario is different. In the past, most patients were diagnosed in advanced stages, and treatment was bilateral orchidectomy. With an increase in the longevity of life, education, awareness and availability of prostate-specific antigen testing, the number of patients of cancer prostate is increasing every year. Cancer registries in India are reporting prostate cancer as becoming more common in men. [1] There is also a stage migration, and early cases in younger men are being diagnosed. This increases the responsibility of the treating doctors vis-à-vis proper planning and management so that these patients can have prolonged survival with a good quality of life. RALP started in India in 2006. Short-term data on outcome have been published but long-term results are awaited. [2]

There are several unanswered questions regarding RP. Patient selection, role in low risk, intermediate- and high-risk disease, role in salvage situations, problems of surgery in narrow pelvis and obese individuals, role of lymphadenectomy, functional outcomes like incontinence and erectile dysfunction - all need further evaluation and discussion. In this issue of the Journal, we have invited experts to answer the above questions. They have reviewed and analyzed the literature and provide current perspective in their respective fields. We are grateful to them for these endeavors. I hope that these articles will benefit the readers and help them update themselves on RP.

 
   References Top

1.National Cancer Registry Programme of ICMR http://www.icmr.nic.in/ncrp/trend%20report%201982_2010/ALL_PDF/Individual_Registry_Leading_Site_Graphs.pdf. [Last accessed on 2014 Jul 10].  Back to cited text no. 1
    
2.Dogra PN, Javali TD, Singh P, Kumar R, Seth A, Gupta NP, et al. Peri operative outcome of initial 190 cases of robot assisted laparoscopic radical prostatectomy - A single center Experience. Indian J Urol 2012;28:159-63.  Back to cited text no. 2
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