Expert laparoscopic surgeons have demonstrated that laparoscopic radical
prostatectomy with or without robotic assistance can be performed with excellent results. There is no evidence that laparoscopic radical
prostatectomy with or without robotic assistance offers any clinically relevant advantage over open radical
prostatectomy. Laparoscopic radical
prostatectomy with or without robotic assistance requires a significant learning curve, is a longer
surgical procedure, carries greater costs, and requires an expanded operating room team. The literature suggests that laparoscopic radical
prostatectomy is associated with more
intraoperative complications and higher
positive surgical margins. The lesser amount of postoperative
bleeding associated with laparoscopic radical
prostatectomy is not clinically relevant. Laparoscopic radical
prostatectomy is not associated with less
pain and does not facilitate earlier
urinary catheter removal. The best way to improve overall outcomes after radical
prostatectomy is to direct patients to expert open or laparoscopic surgeons.