Robotic arm holding prostate

Robotic Prostatectomy: Is Experience Overrated?

Kai Mendoza in Health & Wellness December 2025 • 4 min read.

"Debunking the Myth: Robotic Surgery Success Without Laparoscopic Expertise"

Prostate cancer is a prevalent concern, ranking as the most common tumor after non-melanoma skin malignancies. For individuals diagnosed in the early stages, surgery often stands as a primary treatment option. Among the surgical approaches, robotic-assisted radical prostatectomy (RARP) has emerged as a frequently employed method.

The rise of RARP marks a significant advancement, particularly in its enhanced visualization capabilities during surgery compared to traditional open procedures. This improved visibility empowers surgeons to navigate intricate anatomical structures with greater precision, especially when performing nerve-sparing techniques aimed at preserving crucial functions.

While robotic surgery presents numerous advantages, it's essential to acknowledge the ongoing discussions surrounding its learning curve and cost-effectiveness compared to other approaches. However, emerging research suggests that the need for prior laparoscopic experience before undertaking RARP may not be as critical as once believed. This article delves into a comparative analysis of RARP performed by surgeons without prior laparoscopic expertise against traditional open procedures, shedding light on the efficacy and outcomes of this innovative approach.

RARP vs. Open Prostatectomy: Key Differences & Outcomes

A recent study compared robot-assisted radical prostatectomy (RARP) performed by surgeons without prior laparoscopic experience to open prostatectomy performed by experienced surgeons. The study involved 84 patients, with 50 undergoing RARP and 34 undergoing open surgery. Researchers collected data prospectively and analyzed clinical aspects and perioperative outcomes over a minimum of 12 months.

Several key differences emerged between the two groups:

Operative Time and Hospitalization: RARP demonstrated shorter operative times and reduced hospital stays compared to open surgery.
Blood Loss: Patients undergoing RARP experienced less blood loss during the procedure.
Functional Outcomes: The RARP group exhibited better trifecta and pentafecta outcomes, indicating superior results in achieving urinary continence, sexual function, and cancer control. They also achieved continence earlier than the open surgery group.
Surgical Margins: While positive surgical margins were similar between the groups, the open surgery group had a higher incidence of extraprostatic extension (cancer spread beyond the prostate).

The results suggest that RARP can be a safe and effective procedure even in the hands of surgeons without prior laparoscopic experience. The study highlights the potential for improved operative outcomes and functional results with this modern approach.

The Future of Prostate Cancer Surgery: Accessibility and Innovation

This study offers compelling evidence that robotic-assisted radical prostatectomy is a safe and viable option, even when performed by surgeons without extensive laparoscopic experience. This finding challenges traditional assumptions and opens doors for more surgeons to adopt this advanced technique, potentially expanding access to minimally invasive prostate cancer treatment for patients.

The superior outcomes observed with RARP, including reduced operative time, blood loss, and improved functional results, underscore the benefits of this modern approach. As technology continues to evolve and surgical training programs adapt, robotic surgery is poised to play an increasingly prominent role in the management of prostate cancer.

For patients, these findings offer reassurance that excellent surgical outcomes are attainable, even when choosing a surgeon who may not have years of prior laparoscopic experience. The focus should be on selecting a skilled and well-trained robotic surgeon who is committed to providing personalized and comprehensive care.

About this Article -

This article was crafted using a human-AI hybrid and collaborative approach. AI assisted our team with initial drafting, research insights, identifying key questions, and image generation. Our human editors guided topic selection, defined the angle, structured the content, ensured factual accuracy and relevance, refined the tone, and conducted thorough editing to deliver helpful, high-quality information.See our About page for more information.

This article is based on research published under:

DOI-LINK: 10.1590/s0102-8650201500300000011, Alternate LINK

Title: Is Previous Experience In Laparoscopic Necessary To Perform Robotic Radical Prostatectomy? A Comparative Study With Robotic And The Classic Open Procedure In Patients With Prostate Cancer

Subject: Surgery

Journal: Acta Cirurgica Brasileira

Publisher: FapUNIFESP (SciELO)

Authors: Felipe Monnerat Lott, Luciano Alves Favorito

Published: 2015-03-01

Everything You Need To Know

What are the main advantages of robotic-assisted radical prostatectomy (RARP) compared to traditional open prostatectomy?

Robotic-assisted radical prostatectomy or RARP offers enhanced visualization, enabling surgeons to navigate intricate anatomical structures with greater precision, particularly during nerve-sparing techniques. This is a major advantage over traditional open procedures. However, the learning curve and cost-effectiveness of RARP remain subjects of discussion.

What specific benefits did patients experience in terms of operative time, hospitalization, blood loss, and functional outcomes when undergoing robotic-assisted radical prostatectomy (RARP)?

The study indicated that patients undergoing robotic-assisted radical prostatectomy experienced shorter operative times and reduced hospital stays. They also experienced less blood loss during the procedure when compared to open surgery. Furthermore, the group who had RARP exhibited better trifecta and pentafecta outcomes, which means superior results in achieving urinary continence, sexual function, and cancer control.

What exactly are 'trifecta' and 'pentafecta' outcomes in the context of prostatectomy, and why are they important?

Trifecta outcomes in prostatectomy refer to the achievement of three key goals: cancer control (negative surgical margins), urinary continence, and preservation of sexual function. Pentafecta outcomes expand on this by adding the absence of complications and the absence of biochemical recurrence (rising PSA levels). Achieving these outcomes indicates a highly successful surgical result.

What are the implications of the finding that surgeons can perform robotic-assisted radical prostatectomy (RARP) effectively without prior extensive laparoscopic experience?

The study suggests that surgeons can achieve proficiency in robotic-assisted radical prostatectomy without extensive prior experience in laparoscopic surgery. This could broaden the adoption of RARP, offering more patients access to minimally invasive prostate cancer treatment. It challenges the traditional belief that laparoscopic expertise is a prerequisite for successful robotic surgery.

What do 'positive surgical margins' and 'extraprostatic extension' mean in the context of prostate cancer surgery, and how did the rates of these compare between robotic-assisted radical prostatectomy (RARP) and open surgery?

Positive surgical margins mean that cancer cells were found at the edge of the removed tissue, indicating that some cancer may still be present. Extraprostatic extension refers to the spread of cancer beyond the prostate gland. While positive surgical margins were similar between the groups, the open surgery group had a higher incidence of extraprostatic extension, suggesting that RARP may offer better cancer control in terms of containing the disease within the prostate.