Robotic-assisted simple prostatectomy: is there evidence to go beyond the experimental stage?

Open simple prostatectomy (OSP) is an effective and durable treatment for select patients with symptomatic benign prostatic hyperplasia (BPH) and large-volume prostate glands (>80 cc), yet is associated with clinically significant risk of bleeding, transfusion, prolonged hospital length of stay (LOS), and complications. Robotic-assisted simple prostatectomy (RASP) potentially reduces intraoperative blood loss and improves perioperative outcomes. Thirteen non-comparative series (Level 3 evidence) of RASP have established its safety and efficacy and have demonstrated substantially decreased risk of transfusion, complications, and mean LOS relative to published series of OSP, but with consistently longer operative times. Comparative outcomes data (Level 1 and Level 2 evidence), however, are relatively lacking. Thus, while RASP has advanced beyond the experimental stage, definitive outcomes studies are needed to establish its benefits and costs relative to OSP and transurethral surgery.