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Logo of nihpaAbout Author manuscriptsSubmit a manuscriptNIH Public Access; Author Manuscript; Accepted for publication in peer reviewed journal;
 
J Urol. Author manuscript; available in PMC Mar 4, 2014.
Published in final edited form as:
PMCID: PMC3941982
NIHMSID: NIHMS524075
Commentary: Robotic Radical Prostatectomy is an Effective Approach for Treating Localized Prostate Cancer—is it Technique or Technician?
Ashutosh Tewari and Misop Han
Ashutosh Tewari, New York Presbyterian Hospital, New York, New York;
In this issue of The Journal Liss et al (page 2205) confirm that robotic prostatectomy is an oncologically safe and effective modality with 5-year biochemical recurrence-free survival outcome comparable to that of open radical prostatectomy.1 In their study, while biological variables such as Gleason grade and pathological stage were the major determinants of biochemical recurrence, an iatrogenic positive surgical margin also increased the risk for recurrence. In that regard, the masters of open radical prostatectomy taught us that attaining negative surgical margin while preserving continence and sexual recovery is a challenging task and that a continued learning process based on feedback can result in improved surgical technique.2
To compare and appreciate the differences in surgical techniques in attempting to reduce apical positive margin rates,3 we selected the video “Nerve-sparing retropubic radical retropubic prostatectomy with extracapsular dissection: quality of surgical excision” (2010 V0476) and the video “Anatomic retro-apical technique for synchronous posterior-anterior approach to apical transection during robotic radical prostatectomy” (2010 V0474). We wish to emphasize that clear understanding of surgical anatomy, delicate tissue handling and attention to details are the common factors for attaining optimal outcomes regardless of surgical approach.
Notes
This is a commentary on article Liss MA, Lusch A, Morales B, Beheshti N, Skarecky D, Narula N, Osann K, Ahlering TE. Robot-assisted radical prostatectomy: 5-year oncological and biochemical outcomes. J Urol. 2012;188(6):2205-10.
Contributor Information
Ashutosh Tewari, New York Presbyterian Hospital, New York, New York.
Misop Han, The Johns Hopkins Medical Institutions, Baltimore, Maryland.
REFERENCES
1. Liss MA, Lusch A, Morales B, et al. Robot-assisted radical prostatectomy: 5-year oncological and biochemical outcomes. J Urol. 2012;188:2205. [PubMed]
2. Tewari AK, Srivastava A, Huang MW, et al. Anatomical grades of nerve sparing: a risk-stratified approach to neural-hammock sparing during robot-assisted radical prostatectomy (RARP) BJU Int. 2011;108:984. [PubMed]
3. Tewari AK, Srivastava A, Mudaliar K, et al. Anatomical retro-apical technique of synchronous (posterior and anterior) urethral transection: a novel approach for ameliorating apical margin positivity during robotic radical prostatectomy. BJU Int. 2010;106:1364. [PubMed]