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The case for robot-assisted radical prostatectomy.

MANAGEMENT of clinically localized prostate cancer is one of the most controversial subjects in the field of urologic oncology. Because of the lack of randomized trials, it is difficult, if not impossible, to compare two modalities used for treating an identical patient. Therefore, we will approach this debate more as an intellectual exercise, focusing on key outcome parameters. This exercise is not meant to give comparative data. Both laparoscopy and robotics are minimally invasive modalities. The goals of both are the same: To achieve oncologic control through negative margins and, in selected patients, to minimize damage to nervous tissue responsible for erections and urinary continence. Having said that, we enjoy performing robot-assisted prostatectomy and believe that the goals of prostatectomy are achievable using robotics in our hands. We present some technical, conceptual, and personal outcomes data to support our conclusions and provide objective data to clarify questions posed by the debate.