# New Evolution of Robotic Radical Prostatectomy: A Single Center Experience with PERUSIA Technique
## 5 Discussion  
### Why Robotics in Radical Prostactotomy? In a recent systematic review of the literature, [PERSON] et al. highlighted the safety of radical prostatectomy with the robotic technique, in terms of peri-operative outcomes: the mean operative time was about 152 min (range 90-291 min), the mean blood loss was estimated at about 166 mL (range 69-534 mL), the average length of stay was 1.9 days (range 1-6 days), and the average catheterization time was approximately 6.3 days (range 5-8.6 days). The overall rate of postoperative complications was 9% (range 3-26%) and, sub-dividing them according to the classification of Clavien-Dindo, they were 4% of I degree, 3% of II degree, 2% of III degree, 0.4% of IV degree, and 0.002% of V degree. The most frequently reported complications were lymphochele (3.1%), urine leakage (1.8%), and the need for reoperation (1.6%). Comparing the peri-operative outcomes and complications related to the three different approaches, the authors found no statistically significant difference, except for a lower need for transfusions in patients undergoing robotic radical prostatectomy [13; 14]. Patients who underwent \"open\" radical prostatectomy in high-volume centers in Europe and the USA have, 15 years after surgery, a biochemical recovery-free survival of up to 75% and cancer-specific mortality ranging from 7% to 20% [15; 16]. The data present in the literature on the oncological results of robot-assisted radical prostatectomy are evaluated and reported in a not very homogeneous way and are still limited in time; therefore, evaluating the oncological efficacy of the robotic approach in terms of positive surgical margins, which is needed for every technique to be safe, showing an average value of 15% (range 6.5%-32%). By stratifying these data concerning the extent of the disease, the positive surgical margins were 9% in pT2, 37% in pT3, and 50% in pT4. PSMs are more frequent at the prostatic apex followed by a posterolateral site and represent a negative prognostic factor for PCa [17]. Gleason grade, PSMs length, and multifocality were all associated with worse BCR-free survival [18]. Survival in the absence of biochemical progression was 90% at 3 years after surgery, 87% at 5 years, and 81% at 7 years. In a randomized phase III study, the robotic approach, while making it possible to reduce blood losses and new post-surgery hospitalizations, did not improve the oncological results, even if evaluated at 3 months [19; 20; 21]. Furthermore, even in a recent systematic review of the literature, it is highlighted that comparing the oncological outcomes of the robotic approach with the \"open\" and laparoscopic ones, there are no statistically significant differences either in terms of positive surgical margins or biochemical recurrence [22]. Urinary incontinence and erectile disfunction are the main complications of radical prostatectomy. The prevalence of urinary incontinence 12 months after laparotomyic radical prostatectomy is between 7% and 40%, depending on whether a patient is considered continent who does not need protection at all or a patient who needs one safety pad at most. Similar are the  
Figure 2: Potency rate after Perusia RARP. data on urinary incontinence 12 months after laparoscopic radical prostatectomy with a range from 5% to 34%, and the cumulative analysis of comparative studies between the two approaches, which were performed in a systematic review of the literature, confirmed that the functional results in terms of urinary continence are comparable [23]. In a recent systematic review of the literature, [PERSON] et al. reported an average prevalence of urinary incontinence at 12 and 24 months after robotic radical prostatectomy of 16% (range 4-31%) and 12%, respectively, when only patients who did not use pads were considered to be incontinent; if patients who needed a maximum of one safety pad were also included, the average rate was 9% (range 8-11%) at 12 months and 5% at 36 months after surgery.