Evolution of robotic surgery in the treatment of localized prostate cancer.

Adenocarcinoma of the prostate is the second most common cancer in men in the United States (following only skin cancer) and accounts for 33% of all newly diagnosed male cancers. It is estimated that in 2007, 218,890 men will be diagnosed with prostate cancer and 27,050 will die from this disease. While most currently diagnosed prostate cancers are localized, radical prostatectomy remains a gold standard treatment. Since its original description, radical retropubic prostatectomy has evolved over the last three decades to a precise, sophisticated procedure with minimal mortality, and excellent surgical outcomes. However, despite its efficacy, open surgical treatment is inherently associated with blood loss and significant pain. Due to these reasons, many men have sought other, less invasive forms of treatment. With its development in the late 1990s, minimally invasive surgery has significantly and irrevocably changed the surgical treatment of prostate cancer. Robotic-assisted technology has further propelled the utilization of the laparoscopic approach for radical prostatectomy, particularly for non-laparoscopic trained surgeons. The implementation of robotic technology has been rapid. Presently, 7 years after its approval by the FDA, many hospitals have established for robotic-assisted radical prostatectomy programs. This trend will undoubtedly continue to grow as more surgeons become familiar with the procedure, more robotic systems become available, and increasingly mature data is published. Robotic-assisted laparoscopic radical prostatectomy allows patients the benefits of minimally invasive surgery with functional and oncological results comparable to those from open and standard laparoscopic procedures, we believe that this surgical approach will shortly evolve into the standard surgical approach for localized prostate cancer.