Robotic assisted radical prostatectomy versus open retropubic radical prostatectomy: Where do we stand in 2015?

Robotic assisted radical prostatectomy has emerged as the dominant surgical technique for the management of localised prostate cancer in many Western countries. Yet the evidence to support such a radical change in surgical technique has been limited and of poor quality, with the driver of the change initially being aggressive marketing, followed by hospital and urologist competition, and lastly by patients themselves who perceive robotic assisted radical prostatectomy to be the better technique. A critical review of the contemporary literature would suggest that robotic assisted radical prostatectomy may indeed have benefits over traditional open surgery in the areas of length of inpatient stay, perioperative complications and transfusion rates. However, the important parameters of cancer control, continence and potency outcomes appear largely equivalent between the techniques and more determined by surgeon and hospital experience, and patient characteristics, with the advantages of robotic surgery coming at increased cost. There is no question that robotic assisted radical prostatectomy is already widely disseminated and this trend is irreversible regardless of the outcomes of future studies. This however, does pose challenges regarding training in centres that do not have access to robotic technology, credentialing requirements for transitioning open surgeons and maintenance of open skills where robotic assisted radical prostatectomy cannot be performed.