Review Article DOI 10.3349/ymj.2009.50.2.177 pISSN: 0513-5796, eISSN: 1976-2437 Yonsei Med J 50(2):177-181, 2009 Robotic Prostatectomy: What We Have Learned and Where We Are Going David I. Lee Division of Urology, University of Pennsylvania School of Medicine, Philadelphia, PA, USA. Radical prostatectomy became a mainstay of treatment for prostate cancer in the United States after the pioneering work of Walsh in defining the nerve sparing technique. Efforts to reproduce this operation in a minimally invasive fashion resulted in slow progress that recently have flourished with the application of the daVinci Surgical System (Intuitive Surgical, Sunnyvale, CA, USA) by Menon and colleagues. This article summarizes the origins of robotic prostatectomy, some of the current data regarding this operation and potential future directions. Key Words : Robotic surgery, prostatectomy, prostate cancer, minimally invasive surgery, laparoscopy Received: February 17, 2009 Corresponding author: Dr. David I. Lee, Division of Urology, University of Pennsylvania School of Medicine, Penn Presbyterian Medical Center, 51 N. 39th Street, MOB Suite 300, Philadelphia, PA 19104, USA. Tel: 1-215-662-8699, Fax: 1-215-243-2060 E-mail: david.lee@uphs.upenn.edu © Copyright: Yonsei University College of Medicine 2009 INTRODUCTION Robot assisted radical prostatectomy (RARP) is one of the most common treatments for prostate cancer in the United States. The adoption of this procedure has been very rapid. The first reported procedure was in 20001 however in 2007 more than 60% of all radical prostatectomy cases were robotically assisted (Intuitive Surgical data, Sunnyvale, CA, USA). The focus of this paper will examine the reported outcomes of this technology including our centers’ experience. Future directions will also be explored. BACKGROUND The first reported radical prostatectomy was performed by Hugh Hampton Young in 1904 via a perineal approach.2 The retropubic approach was first performed by Terrence Millen in 1947.3 However, the morbidity of these operations caused both patient and surgeon alike to avoid this curative treatment. External beam radiation provided a viable alternative albeit a less efficacious one with its own set of morbidities. Patrick Walsh’s revolutionary contributions in defining the anatomy of the prostate and its surrounding structures began to turn the tide.4 No longer was the treatment more harmful than the disease. Patients could undergo radical prostatectomy and have an excellent chance of regaining continence and potency postoperatively. Over the years since Dr. Walsh’s seminal work, many centers have developed expertise with open radical prostatectomy. The operation including the concepts of suturing the dorsal venous complex and nerve sparing had become the mainstay of treatment for men with organ confined prostate cancer. However, the advent of large organ ablative urological surgery was dawning in the early 1990’s heralded by Dr. Ralph Clayman’s report of the first laparoscopic nephrectomy.5 Later careful examination demonstrated the benefits of the laparoscopic nephrectomy with less pain, less blood loss, quicker return to work and shorter hospital stay.6 Dunn and Yonsei Med J http://www.eymj.org Volume 50 Number 2 April 2009 177