Retrograde robot-assisted radical prostatectomy in a patient with localized prostate cancer: a case report

Comparison of Oncological Outcomes Between Open Radical Prostatectomy and Robotic-Assisted Radical Prostatectomy for Localized Prostate Carcinoma: A Systematic Review of Randomized Controlled Trials and Primary Studies

Introduction: Prostate carcinoma (PCa) is the second most frequently diagnosed malignancy in males globally, and radical prostatectomy (RP) constitutes the cornerstone of curative-intent surgical management for localized disease. Open radical prostatectomy (ORP) has been the historical gold standard; however, robotic-assisted radical prostatectomy (RARP) has experienced rapid, widespread adoption over the past two decades. Despite this diffusion, comparative oncological efficacy between the two platforms has remained under debate. This systematic review comprehensively compares oncological outcomes—including positive surgical margin (PSM) rates, biochemical recurrence (BCR), prostate cancer-specific survival (PCSS), overall survival (OS), and perioperative oncological parameters—between ORP and RARP for clinically localized PCa. Methods: The study strictly adhered to the Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) 2020 guidelines. Eligible studies included randomized controlled trials (RCTs), cohort studies (prospective and retrospective), case-control studies, and cross-sectional observational studies directly comparing ORP with RARP in patients with clinically localized PCa. Risk of bias was evaluated using the Cochrane Risk of Bias 2 (RoB 2) tool for RCTs and the Newcastle-Ottawa Scale (NOS) for observational studies. Results: Twenty primary studies (3 RCTs, 17 observational cohort studies) encompassing >700,000 patients were included. RARP demonstrated lower PSM rates in the majority of large observational studies (OR 0.56–0.88, p<0.001 in several series), while results from RCTs were non-inferior but not significantly different. BCR rates were similar in RCTs (non-significant at 24–36 months), but long-term cohort data (12-year follow-up LAPPRO trial) demonstrated significantly lower PCSS-mortality in the RARP group (HR 0.36; 95% CI 0.23–0.55). RARP offered significant perioperative advantages: reduced estimated blood loss (192–250 vs. 710–852 mL), decreased transfusion rates, shorter hospitalization, fewer major postoperative complications, and lower 30-day mortality. Functional recovery of urinary continence and erectile function was superior in early time points for RARP, with equivalence observed at 24 months in RCTs. Discussion: The data synthesis from RCTs and large observational cohorts indicates that RARP is at least oncologically non-inferior to ORP across short- to medium-term follow-up periods, with accumulating long-term evidence suggesting potential superiority in PCSS. Perioperative and functional advantages of RARP are well-established. The surgeon learning curve, institutional volume, and patient risk stratification are critical confounders that must be considered when interpreting comparative data. The heterogeneity of follow-up durations and BCR definitions across studies constitutes a significant limitation of the current evidence base. Conclusion: RARP demonstrates oncological outcomes equivalent to ORP in short- and medium-term follow-up, with emerging long-term evidence supporting potential superiority in PCSS. Given its robust perioperative and functional advantages, RARP may be considered the preferred surgical approach for localized PCa in high-volume robotic centers. Large-scale, long-term RCTs remain necessary to definitively establish oncological equivalence or superiority.

Robot-assisted radical prostatectomy for high-risk and locally advanced prostate cancer: a bibliometric and evidence-mapping analysis of oncologic safety, functional outcomes, lymph-node management, and multimodal treatment

Keyword and co-citation findings indicated a gradual transition from early surgical experience, learning-curve assessment, and technical feasibility toward research on oncologic outcomes, lymph-node management, functional recovery, and multimodal treatment within this patient population.

Early experience with robot-assisted radical prostatectomy using the Toumai system: outcomes from the first African series of 134 patients

Robot-Assisted Radical Prostatectomy in a Patient with Pre-existing Femoral Crossover Bypass Graft: Multidisciplinary Management and Outcomes.

Robot-assisted radical prostatectomy (RARP) has become the standard surgical treatment for localized clinically significant prostate cancer, yet in patients with pre-existing pelvic vascular grafts, such as the iliofemoral graft, there is a significant risk of iatrogenic injury during abdominal access and pelvic dissection. This report describes a 69-year-old male with D'Amico intermediate-risk prostate cancer and a right iliofemoral polytetrafluoroethylene (PTFE) crossover bypass graft implanted for peripheral arterial disease. Major comorbidities included obesity (BMI 32 kg/m2), ASA III status, prior myocardial infarction with coronary stents, insulin-dependent type 2 diabetes, atrial fibrillation on apixaban, and Peripheral arterial disease under continuous antiplatelet therapy with aspirin. Preoperative magnetic resonance angiography enabled three-dimensional reconstruction of the graft course; vascular surgeons marked the graft trajectory directly on the abdominal wall to guide safe trocar placement. Aspirin continued perioperatively. Transperitoneal anterior RARP was performed with extended pelvic lymph node dissection (28 nodes, pN0). The graft was visualized intraperitoneally and avoided; cold scissors were used for dissection to minimize thermal injury. Operative time was 150 min, with an estimated blood loss of 300 mL. Final pathology revealed pT3a pN0 R0 disease with 4.8 cm3 tumor volume. Immediate continence was achieved after catheter removal. Graft patency was verified by Doppler ultrasound on day 1 and before discharge. PSA was undetectable (< 0.01 ng/mL) at 8 weeks and thereafter. This case illustrates that meticulous multidisciplinary planning enables safe RARP in high-risk patients.

Global research trends and hotspots of urinary incontinence after robot-assisted radical prostatectomy: a bibliometric and visual analysis

A bibliometric and visualization analysis of global RARP incontinence research, aiming to provide a reference for clinicians and researchers working to improve continence outcomes, found the United States led in both publication volume and total citations, followed by Japan and Italy.

Impact of Biopsy-to-Radical Prostatectomy Interval on Adverse Pathological Outcomes in High-Risk Localized and Locally Advanced Prostate Cancer

No statistically significant independent association was detected between a biopsy-to-radical prostatectomy interval ≥90 days and extraprostatic extension, seminal vesicle involvement, or positive surgical margins, and residual confounding from clinician-driven prioritisation and unmeasured preoperative factors cannot be excluded.