How to Skin a Prostate: The Evolution of Robotic Prostatectomy

Since the introduction of radical prostatectomy by Hugh Hampton Young in 1905, this surgery has undergone constant evolution. With increasing appreciation for the impact of functional preservation on cancer survivorship, urologists have been steadfast in their pursuit of precision surgery to eradicate cancer while maximally preserving the surrounding anatomical structures. In the 1990s and 2000s, the introduction of laparoscopic and robotic prostatectomy brought about welcome improvements including decreased intra-operative blood loss, decreased postoperative pain, shorter hospital length of stay, and faster recovery. Recognizing that focality of prostate cancer lends itself well to precision surgery, robotic surgeons have attempted to exploit the enhanced vision and dexterity provided by the instrument to further improve outcomes. Over the last decade, new techniques have been introduced to help reduce the incidence of incontinence and erectile dysfunction, the 2 most often encountered complications following prostatectomy.