# New Evolution of Robotic Radical Prostatectomy: A Single Center Experience with PERUSIA Technique
## 5 Discussion
### Why Robotics in Radical Prostactotomy?
The cumulative analysis of the comparative studies between the robotic technique and the \"open\" and laparoscopic technique revealed a better result at 12 months of both robotic surgery than the \"open\" (7.5% vs. 11.3%) with a reduction in absolute risk of 3.8%, both compared to laparoscopic (5% vs. 9.6%) with an absolute risk reduction of 4.6% [24]. In another systematic review, which included two randomized controlled trials comparing the results of robotic radical prostatectomy with those of laparoscopic, the authors found an improved recovery of urinary continence in patients treated with robotic technique (RR: 1.14; 95% CI: 1.04-1.24). However, the results may have been affected by the small size of the study populations [25]. It should also be emphasized that the reported results may be affected by the preoperative clinical characteristics of the patients, the surgeon's experience, the surgical technique, and the methods used to collect and report data. In fact, as with the laparotomic and laparoscopic approach, age, comorbidities, obesity, and the presence of lower urinary tract symptoms are also factors associated with a worse functional result in terms of urinary continence for the robotic approach [8]. On the other hand, in a randomized phase III study, in which the functional results of the three approaches were compared with a follow up of 24 months, [PERSON] et al. found no significant difference between the three different techniques [19]. The prevalence of erectile deficit at 12 months after radical retropubic prostatectomy with nerve-sparing technique varies from 14% to 69%, after laparoscopic radical prostatectomy from 24% to 58% and after robotic radical prostatectomy from 20 to 30% [23; 26]. In one of the first comparative studies between open radical and robotic prostatectomy, [PERSON] et al. showed a faster recovery of sexual potency in patients undergoing robotic surgery (180 days vs. 440 days) [27]. An advantage in terms of recovery of sexual potency was highlighted in a systematic review of the literature, which included studies with case series exceeding 100 cases of robotic radical prostatectomy: the average rate of sexual potency at 3, 6, 12, and 24 months was 50%, 65%, 70%, and 79%, respectively, and independent predictors were age, preoperative IIEF-5, Charlson Comorbidity Index, bilateral nerve-sparing performance, and athermic dissection. The cumulative analysis of six studies comparing sexual potency at 12 months between the open and the robotic approach showed that the latter allowed a reduction in the absolute risk of impotence by 23.6%, with a prevalence of erectile deficit respectively by 47.8% and 24.2% [28]. This result was confirmed by [PERSON] et al. in a prospective comparative evaluation at 24 months of follow up: the erectile deficit rate was 53% after open surgery and 16% after robotic surgery (OR: 6.01; 95% CI, 4.25-8.49; \(p<0.001\)) [29]. Then, the same authors performed the cumulative analysis of four studies, one of which is randomized controlled, and three retrospectives, which compared the prevalence of impotence after laparoscopic and robotic radical prostatectomy. The study showed a better result for the latter, although it was not statistically significant (OR: 1.89; 95% CI, 0.70-5.05; \(p=0.21\)) [29]. However, the only prospective randomized study showed a significant advantage provided by the robotic technique with a prevalence of sexual potency at 12 months of 77% compared to 32% for laparoscopy [30]. A recent systematic review of the literature, which included two prospective randomized studies involving a total of 446 patients, compared peri-operative, oncological, and functional outcomes between minimally invasive radical prostatectomy (laparoscopic or robotic) and \"open\".