[Radical prostatectomy--100 years of evolution].

Abstract

Prostate cancer is the most common malignant disease in men. The incidence of prostate cancer has been rising since the early 1990s. Not all men inflicted by prostate cancer will develop clinical disease. Therefore, sorting these cases is a great clinical challenge. Radical prostatectomy has undergone evolution in the last 100 years. Better understanding of the pelvic anatomy has led to a decrease in the blood loss during surgery and in the rate of urinary incontinence and erectile dysfunction following surgery. The introduction of laparoscopy in the late 1990s to this surgery provided the surgeon with a magnified multi-angle field of view and facilitated accurate dissection and suturing. Decreased damage to neighboring tissue made recovery hastier. Nevertheless, laparoscopic radical prostatectomy is a technically challenging surgery and did not become popular. The last step in the evolution of radical prostatectomy is the introduction of robotic systems for assistance in laparoscopic radical prostatectomy. A master-slave robotic system is composed of console and mechanical arms. The surgeon is provided with a magnified three dimensional view of the operative field and with two mechanical arms that accurately replicate its fingers movements. The initial results of robotic-assisted laparoscopic prostatectomy seem promising, however, long-term follow-up and comparison to open surgeries are lacking. Robotic systems were rapidly implemented in the American market and in the year 2006, 40% of all radical prostatectomies were robotic assisted. Future systems may reveal deep structures to the visualized surface by superimposing MRI images on the surgical field.