David I. Lee were controlled for, surgeon volume was a clear independent risk factor for a positive surgical margin. Furthermore, PSA recurrence in a similar study by Klein revealed a similar result.20 As such, as the robotic prostatectomy surgical experience broadens, the outcomes should continue to improve. However, the robotic and laparoscopic approaches have brought innovation to radical prostatectomy. The vanVelthoven anastomosis was made possible by a laparoscopic approach; the technique involves the creation of the urethrovesical anasto- mosis by a double armed suture that is initiated at the 6 o’clock position and run continuously to the 12 o’clock position with a single knot at the top.21 This technique has proved reliable, rapid with a minimum of complications such as urine leak or bladder neck contractures. Menon has reported the Veil of Aphrodite technique of nerve sparing where the prostatic fascia is incised very anteriorly. The goal of the approach is to spare anterior accessory nerves that may be important for potency. Improved potency was indeed demonstrated for men with normal preoperative potency in a small study comparing these patients to a historical control of standard nerve sparing.22 However, the controversy surrounded this technique despite the positive outcomes due to a concern of closer margins. However, these data led to a comparative study by Walsh where he examined a high anterior fascia release (HAR) to his standard technique of nerve sparing. He noted clearly improved outcomes where HAR patients had a higher chance of regaining a SHIM score of 16 (93% to 77%). He also did not see an increase in the positive margin rates but theorized that the success of this technique was not improved number of nerves spared but decreased traction on the neurovascular bundle during dissection. Future directions Attempts to further decrease morbidity and increases in computing power and technological innovations will continue to drive progress in robotics and computer assisted surgery. The development of single port surgery is a clear fit with robotic technology. Gettman23 reported transvaginal laparoscopic nephrectomy in the porcine model where a single 5 mm tran- sabdominal port was used in conjunction with a multiple ports placed through the vagina. Successful nephrectomy was performed in 5 out of 6 animals. The relatively rudimentary devices used in this report have been improved with develop- ment of articulating instruments and single site access ports that allow multiple instrument passage. Kaouk24 has reported on laparoscopic single port prostatectomy in 4 patients. Mean OR time was 285 minutes and EBL was 288 cc. No intraoperative complications occurred. One patient did develop a rectourethral fistula. Refinement of robotic tools will allow further explora- tion and refinement of this challenging technique. Other scientific breakthroughs will lead to the ability to ‘see’ structures that cannot be seen with the naked eye. Boyette et al.25 has reported on optical real time imaging of cavernous nerves with confocal microscopy. This technique was initiated with the creation of a fluorescent nerve tracer. This tracer was injected into the penis of a group of rats. In vivo imaging during laparoscopy using a fiber wand attached to a confocal micro- scope was able to visualize these nerves in the pelvis. In the future, it may be possible to label specific structures that can literally ‘light up’ during a robotic approach. This could enable sparing of certain structures such as nerves and definitive removal of other cancerous tissues. CONCLUSIONS The robotic prostatectomy has indeed become the most common extirpative operation performed for prostate cancer in the United States. However, the development and refinement of this procedure has led to improved outcomes for patients under- going either robotic or open radical prostatectomy. Future improvements are inevitable and soon our imagination will be our only limit to the progress of surgery. REFERENCES 1. Abbou CC, Hoznek A, Salomon L, Lobontiu A, Saint F, Cicco A, et al. [Remote laparoscopic radical prostatectomy carried out with a robot. Report of a case]. Prog Urol 2000;10:520-3. 2. Young HH. The early diagnosis and radical cure of carcinoma of the prostate. Being a study of 40 cases and presentation of a radical operation which was carried out in four cases. 1905. J Urol 2002;167:939-46; discussion 947. 3. Millin T. Retropubic prostatectomy. J Urol 1948;59:267-80. 4. Walsh PC, Lepor H, Eggleston JC. Radical prostatectomy with preservation of sexual function: anatomical and pathological considerations. Prostate 1983;4:473-85. 5. Clayman RV, Kavoussi LR, Soper NJ, Dierks SM, Merety KS, Darcy MD, et al. 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