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Why I Perform Robotic-Assisted Laparoscopic Radical Prostatectomy, Despite More Incontinence and Erectile Dysfunction Diagnoses Compared to Open Surgery: It's Not About the Robot

Published:November 23, 2009DOI:https://doi.org/10.1016/j.eururo.2009.11.030
      For 70 yr following Hugh Hampton Young's perineal radical prostatectomy series, few surgical innovations transpired until improved comprehension of pelvic anatomy and surgical maneuvers to decrease venous bleeding and attenuate erectile dysfunction (ED) led to the widespread adoption of retropubic radical prostatectomy (RRP) [
      • Walsh P.C.
      Anatomic radical prostatectomy: evolution of the surgical technique.
      ]. The advent of prostate-specific antigen furthered additional technical modifications to preclude incomplete prostate resection, as demonstrated by the reduction of postoperative thresholds for organ-confined disease from <0.4 to <0.1. Minimally invasive radical prostatectomy (MIRP) was initially rejected, and then gained traction. MIRP with robotic assistance and the Internet have been disruptive technologies, upsetting traditional word-of-mouth referral patterns by drawing patients to early adopters and Web sites that contain inaccuracies and that heighten expectations regarding potency [

      Mulhall JP, Rojaz-Cruz C, Muller A. An analysis of sexual health information on radical prostatectomy websites. BJU Int. In press.

      ]. This trend may contribute to treatment regret and dissatisfaction with MIRP [
      • Schroeck F.R.
      • Krupski T.L.
      • Sun L.
      • et al.
      Satisfaction and regret after open retropubic or robot-assisted laparoscopic radical prostatectomy.
      ].
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