Which Should a Man Choose: Open or Laparoscopic Prostatectomy?

A new study by Mohamad Allaf, M.D., Director of Minimally Invasive and Robotic Surgery and The Peter Jay Sharp Foundation Scholar, aims at answering this question by comparing the results of patients who have received open prostatectomy with those who have undergone robot-assisted laparoscopic radical prostatectomy (RALP). That the question is now being asked signals how far laparoscopic prostatectomy has come over the last 14 years. “Key anatomical discoveries by Patrick Walsh that enabled surgeons to work in a bloodless field, while sparing the nerves responsible for erections, made open radical prostatectomy the gold standard treatment for men with localized prostate cancer.” The anatomic discoveries helped pave the way for Johns Hopkins urologists to perform the first laparoscopic radical prostatectomy in 1997 — but the procedure was technically diffi cult, and the instruments were much less sophisticated than those available today. “It failed to attain widespread use until the advent of the da Vinci robotic platform,” Allaf continues. RALP has steadily become more popular. “The principles are the same as those of open radical prostatectomy, and the steps of the robotic procedure largely mimic those of the open technique. So, when a patient is faced with the choice of two types of radical prostatectomy, which one should he choose?”

Allaf is studying outcomes, “specifically, the completeness of cancer removal, in addition to quality-of-life measures such as erectile and urinary function,” he says. “Both of these are difficult procedures that require a lot of experience before a surgeon can achieve expert status. Given this, we will analyze the learning curve for these approaches, to shed light on how many procedures are required for a surgeon to achieve competency. We hope our study will set the standard for the results that can be achieved by both open and robotic surgery.”

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