Optimizing Outcomes During Laparoscopic and Robot-assisted Radical Prostatectomy

Robotic technology has fundamentally changed the way we practice surgery, especially within the field of urology. Specifically, the da Vinci Robotic System (Intuitive Surgical, Sunnyvale, CA, USA) has allowed the urologic surgeon greater access to and visualization of pelvic anatomy, including the bladder and prostate along with their neurovascular supply. In the perioperative period, several optimizations can be made to improve patient outcomes, and through careful preoperative management of weight control, smoking cessation, and other factors patients can improve postoperative outcomes. Surgical techniques aimed at preserving and reconstructing anatomic structures, including the bladder neck, endopelvic fascia, puboprostatic ligaments, neurovascular bundle, and urethra, have further augmented the surgeon's ability to hasten patients’ return to continence and potency after surgery. Finally, postoperative treatment with pharmacological, mechanical, and physical therapy have given patients the best possible opportunity to resume their preoperative state of health.