根治性前列腺切除术是治疗局限性前列腺癌的一种手术方式。近年来，随着新的医疗设备和手术技术的出现， 根治性前列腺切除术发生了革命性的演变，其手术方式的演变经历了 3 个阶段：开放手术，微创腹腔镜介入和机器 人辅助手术。腹腔镜或机器人辅助根治性前列腺切除术（RARP）能够改善患者病情，且不影响其肿瘤学预后。特 别是 RARP，由于机器人手术系统的优势可以改进手术技术实现精细操作，能够短期和长期维持尿控和性功能。此外， 研究表明在过去二十年中，它与降低术后发病率相关。本文旨在回顾从开放手术到机器人辅助根治性前列腺切除术 的相关文献，对新术式的优越性进行了分析，并比较了三种术式的优缺点，以期为泌尿外科医师在考虑采用手术治 疗局限性前列腺癌时提供指导。

Radical prostatectomy is a commonly used surgical method in cases of localized prostate cancer. In recent years, with the advent of new medical technologies and surgical techniques, the evolution of radical prostatectomy has revolutionized, especially in robot-assisted radical prostatectomy (RARP). The evolution of surgical approaches for radical prostatectomy has occurred in three stages: open surgery, laparoscopic intervention, and robot-assisted surgery. Regarding the functional recovery of patients who underwent laparoscopic radical prostatectomy or RARP, with the improvement of disease conditions, oncological prognosis of patients was not compromised. Particularly, RARP boasts distinguished novel techniques and approaches for maintaining urinary continence and sexual function in the short- and long-term. In addition, studies in the last two decades have shown its correlation with decreasing postoperative morbidity. In this paper, the available literatures related to the surgical approaches ranging from open surgery to RARP were reviewed, the superiority of any novel procedure was analyzed, and the advantages and disadvantages among the three modalities were compared, hoping to provide guidance to urologists when considering surgical approaches in the treatment of localized prostate cancer.

基金项目：甘肃省自然科学基金（22JR5RA670）；甘肃省人民医院院内科研基金（17GSSY3-4，ZX-62000001-2022-128） 

Foundation Item: Natural Science Foundation of Gansu Province (22JR5RA670); Scientific Research Project of Gansu Provincial  Hospital (17GSSY3-4, ZX-62000001-2022-128) 

通讯作者：李恒平，Email：lhp3350@hotmail.com 

Corresponding Author: LI Hengping, Email: lhp3350@hotmail.com 

引用格式：李恒平，张矛，张向向，等 . 手术机器人的导航系统在皮肤真皮层抽脂的应用 [J]. 机器人外科学杂志（中英文），2025， 6（1）：155-163. 

Citation: LI H P, ZHANG M, ZHANG X X, et al. Critical evolutions in radical prostatectomy and the comparison of three surgical  modalities[J]. Chinese Journal of Robotic Surgery, 2025, 6(1): 155-163.

[1] Siegel R L, Miller K D, Fuchs H E, et al. Cancer Statistics, 2021[J]. CA Cancer J Clin, 2021, 71(1): 7-33. 

[2] XIA C F, DONG X S, LI H, et al. Cancer statistics in China and United States, 2022: profiles, trends, and determinants[J]. Chin Med J (Engl), 2022, 135(5): 584-590. 

[3] YE D W. Where are the future directions in prostate cancer diagnosis and treatment in Asia[J]. Chin J Urol, 2021, 42(9): 641-643. 

[4] Siegel R L, Miller K D, Jemal A. Cancer statistics, 2018[J]. CA Cancer J Clin, 2018, 68(1): 7-30. 

[5] Wallis C J D, Saskin R, Choo R, et al. Surgery versus radiotherapy for clinically-localized prostate cancer: a systematic review and Metaanalysis[J]. Eur Urol, 2016, 70(1): 21-30. 

[6] Wallis C J D, Glaser A, Hu J C, et al. Survival and complications following surgery and radiation for localized prostate cancer: an international collaborative review[J]. Eur Urol, 2018, 73(1): 11-20. 

[7] LI H P, GUO L J. Robot-assisted radical prostatectomy: an update[J]. Zhonghua Nan Ke Xue, 2022, 28(5): 450-455. 

[8] Howard J M. Robotic, laparoscopic, and open radical prostatectomyis the jury still out?[J]. JAMA Netw Open, 2021, 4(8): e2120693. 

[9] Galfano A, Ascione A, Grimaldi S, et al. A new anatomic approach for robot-assisted laparoscopic prostatectomy: a feasibility study for completely intrafascial surgery[J]. Eur Urol, 2010, 58(3): 457-461. 

[10] Menon M, Shrivastava A, Kaul S, et al. Vattikuti Institute prostatectomy: contemporary technique and analysis of results[J]. Eur Urol, 2007, 51(3): 648-657. 

[11] Uy M, Cassim R, Kim J, et al. Extraperitoneal versus transperitoneal approach for robot-assisted radical prostatectomy: a contemporary systematic review and meta-analysis[J]. J Robot Surg, 2022, 16(2): 257-264. 

[12] ZHOU X C, FU B, ZHANG C, et al. Transvesical robot-assisted radical prostatectomy: initial experience and surgical outcomes[J]. BJU Int, 2020, 126(2): 300-308. 

[13] Lenfant L, Garisto J, Sawczyn G, et al. Robot-assisted radical prostatectomy using single-port perineal approach: technique and single-surgeon matched-paired comparative outcomes[J]. Eur Urol, 2021, 79(3): 384-392. 

[14] Sharma V, Meeks J J. Open conversion during minimally invasive radical prostatectomy: impact on perioperative complications and predictors from national data[J]. J Urol, 2014, 192(6): 1657-1662. 

[15] Young H H. The early diagnosis and radical cure of carcinoma of the prostate. Being a study of 40 cases and presentation of a radical operation which was carried out in four cases[J]. 1905. J Urol, 2002, 168(3): 914-921. 

[16] Herranz-Amo F. Radical retropubic prostatectomy: origins and evolution of the technique[J]. Actas Urol Esp (Engl Ed), 2020, 44(6): 408-416. 

[17] Ormond J K. Radical perineal prostatectomy for carcinoma[J]. J Urol, 1947, 58(1): 61-67. 

[18] Millin T. Retropublic urinary surgery[J]. Postgraduate Medical Journal, 1948, 24(267): 38-39. 

[19] Costello A J. Considering the role of radical prostatectomy in 21st century prostate cancer care[J]. Nat Rev Urol, 2020, 17(3): 177-188. 

[20] Chute R. Radical retropubic prostatectomy for cancer[J]. J Urol, 1954, 71(3): 347-372. 

[21] Campbell E W. Total protatectomy with preliminary ligation of the vascular pedicles[J]. J Urol, 1959, 81(3): 464-467. 

[22] DU Y F, LONG Q Z, GUAN B, et al. Robot-assisted radical prostatectomy is more beneficial for prostate cancer patients: a system review and Meta-analysis[J]. Med Sci Monit, 2018. DOI: 10.12659/msm.907092. 

[23] Reiner W G, Walsh P C. An anatomical approach to the surgical management of the dorsal vein and Santorini’s plexus during radical retropubic surgery[J]. J Urol, 1979, 121(2): 198-200. 

[24] Walsh P C, Donker P J. Impotence following radical prostatectomy: insight into etiology and prevention[J]. J Urol, 2017, 197(2S): S165-S170. 

[25] Steiner M S, Morton R A, Walsh P C. Impact of anatomical radical prostatectomy on urinary continence[J]. J Urol, 1991, 145(3): 512- 514; discussion 514-515. 

[26] Walsh P C, Marschke P, Ricker D, et al. Patient-reported urinary continence and sexual function after anatomic radical prostatectomy[J]. Urology, 2000, 55(1): 58-61. 

[27] Kundu S D, Roehl K A, Eggener S E, et al. Potency, continence and complications in 3, 477 consecutive radical retropubic prostatectomies[J]. J Urol, 2004, 172(6): 2227-2231. 

[28] Barre C. Open radical retropubic prostatectomy[J]. Eur Urol, 2007, 52(1): 71-80. 

[29] Hull G W, Rabbani F, Abbas F, et al. Cancer control with radical prostatectomy alone in 1, 000 consecutive patients[J]. J Urol, 2002, 167(2 Pt 1): 528-534. 

[30] Mullins J K, Feng Z, Trock B J, et al. The impact of anatomical radical retropubic prostatectomy on cancer control: the 30-year anniversary[J]. J Urol, 2012, 188(6): 2219-2224. 

[31] Schuessler W W, Schulam P G, Clayman R V, et al. Laparoscopic radical prostatectomy: initial short-term experience[J]. Urology, 1997, 50(6): 854-857. 

[32] Raboy A, Ferzli G, Albert P. Initial experience with extraperitoneal endoscopic radical retropubic prostatectomy[J]. Urology, 1997, 50(6): 849-853. 

[33] Raboy A, Albert P, Ferzli G. Early experience with extraperitoneal endoscopic radical retropubic prostatectomy[J]. Surg Endosc, 1998, 12(10): 1264-1267. 

[34] Basillote J B, Ahlering T E, Skarecky D W, et al. Laparoscopic radical prostatectomy: review and assessment of an emerging technique[J]. Surg Endosc, 2004, 18(12): 1694-1711. 

[35] Stolzenburg J U, Truss M C, Bekos A, et al. Does the extraperitoneal laparoscopic approach improve the outcome of radical prostatectomy?[J]. Curr Urol Rep, 2004, 5(2): 115-122. 

[36] Rassweiler J, Seemann O, Schulze M, et al. Laparoscopic versus open radical prostatectomy: a comparative study at a single institution[J]. J Urol, 2003, 169(5): 1689-1693. 

[37] Basiri A, de la Rosette J J, Tabatabaei S, et al. Comparison of retropubic, laparoscopic and robotic radical prostatectomy: who is the winner?[J]. World J Urol, 2018, 36(4): 609-621. 

[38] Touijer K, Guillonneau B. Laparoscopic radical prostatectomy: a critical analysis of surgical quality[J]. Eur Urol, 2006, 49(4): 625-632. 

[39] Gettman M T, Blute M L. Critical comparison of laparoscopic, robotic, and open radical prostatectomy: techniques, outcomes, and cost[J]. Curr Urol Rep, 2006, 7(3): 193-199. 

[40] Boccon-Gibod L. Radical prostatectomy: open? laparoscopic? robotic?[J]. Eur Urol, 2006, 49(4): 598-599. 

[41] Eastham J A, Scardino P T, Kattan M W. Predicting an optimal outcome after radical prostatectomy: the trifecta nomogram[J]. J Urol, 2008, 179(6): 2207-2210. 

[42] Kaouk J H, Goel R K, Haber G P, et al. Single-port laparoscopic radical prostatectomy[J]. Urology, 2008, 72: 1190-1193. 

[43] GAO X, PANG J, SITU J, et al. Single-port transvesical laparoscopic radical prostatectomy for organ-confined prostate cancer: technique and outcomes[J]. BJU Int, 2013, 112(7): 944-952. 

[44] Alsaid B, Bessede T, Diallo D, et al. Division of autonomic nerves within the neurovascular bundles distally into corpora cavernosa and corpus spongiosum components: immunohistochemical confirmation with three-dimensional reconstruction[J]. Eur Urol, 2011, 59(6): 902- 909.

[45] Desai M M, Aron M, Berger A, et al. Transvesical robotic radical prostatectomy[J]. BJU Int, 2008, 102(11): 1666-1669. 

[46] YANG Y, HOU G L, MEI H B, et al. The Effect of single-port transvesical laparoscopic radical prostatectomy on erectile function and urinary continence compared to intrafascial endoscopic extraperitoneal radical prostatectomy[J]. Urol J, 2020, 17(6): 592-596. 

[47] Walsh P C, Lepor H, Eggleston JC. Radical prostatectomy with preservation of sexual function: anatomical and pathological considerations[J]. Prostate, 1983, 4(5): 473-485. 

[48] Sivaraman A, Sanchez-Salas R, Prapotnich D, et al. Learning curve of minimally invasive radical prostatectomy: comprehensive evaluation and cumulative summation analysis of oncological outcomes[J]. Urol Oncol, 2017, 35(4): 149. e1-149. e6. 

[49] Binder J, Kramer W. Robotically-assisted laparoscopic radical prostatectomy[J]. BJU Int, 2001, 87(4): 408-410. 

[50] Pasticier G, Rietbergen J B, Guillonneau B, et al. Robotically assisted laparoscopic radical prostatectomy: feasibility study in men[J]. Eur Urol, 2001, 40(1): 70-74. 

[51] Hu J C, O’Malley P, Chughtai B, et al. Comparative effectiveness of cancer control and survival after robot-assisted versus open radical prostatectomy[J]. J Urol, 2017, 197(1): 115-121. 

[52] Hori S, Nakai Y, Tomizawa M, et al. Trends in primary treatment for localized prostate cancer according to the availability of treatment modalities and the impact of introducing robotic surgery[J]. Int J Urol, 2022, 29(11): 1371-1379. 

[53] Gandaglia G, Mazzone E, Stabile A, et al. Prostate-specific membrane antigen radioguided surgery to detect nodal metastases in primary prostate cancer patients undergoing robot-assisted radical prostatectomy and extended pelvic lymph node dissection: results of a planned interim analysis of a prospective phase 2 study[J]. Eur Urol, 2022, 82(4) : 411-418. 

[54] Fahmy O, Fahmy U A, Alhakamy N A, et al. Single-port versus multiple-port robot-assisted radical prostatectomy: a systematic review and Meta-analysis[J]. J Clin Med, 2021, 10(24): 5723. 

[55] Gettman M T, Hoznek A, Salomon L, et al. Laparoscopic radical prostatectomy: description of the extraperitoneal approach using the da Vinci robotic system[J]. J Urol, 2003, 170(2 Pt 1): 416-419. 

[56] Galfano A, Di Trapani D, Sozzi F, et al. Beyond the learning curve of the Retzius-sparing approach for robot-assisted laparoscopic radical prostatectomy: oncologic and functional results of the first 200 patients with ≥ 1 year of follow-up[J]. Eur Urol, 2013, 64(6): 974-980. 

[57] Barakat B, Othman H, Gauger U, et al. Retzius sparing radical prostatectomy versus robot-assisted radical prostatectomy: which technique is more beneficial for prostate cancer patients (master study)? a systematic review and Meta-analysis[J]. Eur Urol Focus, 2022, 8(4): 1060-1071 

[58] Lee J, Kim H Y, Goh H J, et al. Retzius sparing robot-assisted radical prostatectomy conveys early regain of continence over conventional robot-assisted radical prostatectomy: a propensity score matched analysis of 1, 863 patients[J]. J Urol, 2020, 203(1): 137-144. 

[59] QIU X F, LI Y J, CHEN M X, et al. Retzius-sparing robot-assisted radical prostatectomy improves early recovery of urinary continence: a randomized, controlled, single-blind trial with a 1-year follow-up[J]. BJU Int, 2020, 126(5): 633-640. 

[60] DENG W, JIANG H, LIU X Q, et al. Transvesical Retzius-sparing versus standard robot-assisted radical prostatectomy: a retrospective propensity score-adjusted analysis[J]. Front Oncol, 2021. DOI: 10.3389/fonc.2021.687010. 

[61] Menon M, Tewari A, Peabody J, et al. Vattikuti Institute prostatectomy: technique[J]. J Urol, 2003, 169(6): 2289-2292. 

[62] Menon M, Shrivastava A, Bhandari M, et al. Vattikuti Institute prostatectomy: technical modifications in 2009[J]. Eur Urol, 2009, 56(1): 89-96. 

[63] Kaouk J, Beksac A T, Abou Zeinab M, et al. Single port transvesical robotic radical prostatectomy: initial clinical experience and description of technique[J]. Urology, 2021. DOI: 10.1016/ j.urology.2021.05.022. 

[64] Villers A, Puech P, Flamand V, et al. Partial prostatectomy for anterior cancer: short-term oncologic and functional outcomes[J]. Eur Urol, 2017, 72(3): 333-342. 

[65] Kaouk J H, Ferguson E L, Beksac A T, et al. Single-port robotic transvesical partial prostatectomy for localized prostate cancer: initial series and description of technique[J]. Eur Urol, 2022, 82(5): 551-558. 

[66] Romero-Otero J, Touijer K, Guillonneau B. Laparoscopic radical prostatectomy: contemporary comparison with open surgery[J]. Urol Oncol, 2007, 25(6): 499-504. 

[67] Touijer K, Eastham J A, Secin F P, et al. Comprehensive prospective comparative analysis of outcomes between open and laparoscopic radical prostatectomy conducted in 2003 to 2005[J]. J Urol, 2008, 179(5): 1811-1817. 

[68] Caras R J, Lustik M B, Kern S Q, et al. Laparoscopic radical prostatectomy demonstrates less morbidity than open radical prostatectomy: an analysis of the American College of SurgeonsNational Surgical Quality Improvement Program database with a focus on surgical trainee involvement[J]. J Endourol, 2014, 28(3): 298-305. 

[69] Yaxley J W, Coughlin G D, Chambers S K, et al. Robot-assisted laparoscopic prostatectomy versus open radical retropubic prostatectomy: early outcomes from a randomised controlled phase 3 study[J]. Lancet, 2016, 388(10049): 1057-1066. 

[70] Coughlin G D, Yaxley J W, Chambers S K, et al. Robot-assisted laparoscopic prostatectomy versus open radical retropubic prostatectomy: 24-month outcomes from a randomised controlled study[J]. Lancet Oncol, 2018, 19(8): 1051-1060.

[71] Lantz A, Bock D, Akre O, et al. Functional and oncological outcomes after open versus robot-assisted laparoscopic radical prostatectomy for localised prostate cancer: 8-year follow-up[J]. Eur Urol, 2021, 80(5): 650-660. 

[72] Wang Y F, Gieschen H, Greenberger M, et al. Survival after roboticassisted prostatectomy for localized prostate cancer: an epidemiologic study[J]. Ann Surg, 2021, 274(6): e507-e514. 

[73] Rozet F, Harmon J, Cathelineau X, et al. Robot-assisted versus pure laparoscopic radical prostatectomy[J]. World J Urol, 2006, 24(2): 171-179. 

[74] d’Altilia N, Mancini V, Falagario U G, et al. A matched-pair analysis after robotic and retropubic radical prostatectomy: a new definition of continence and the impact of different surgical techniques[J]. Cancers (Basel), 2022, 14(18): 4350. 

[75] Chang P, Wagner A A, Regan M M, et al. Prospective multicenter comparison of open and robotic radical prostatectomy: the PROSTQA/RP2 Consortium[J]. J Urol, 2022, 207(1): 127-136. 

[76] Laviana A A, Hu J C. A comparison of the robotic-assisted versus retropubic radical prostatectomy[J]. Minerva Urol Nefrol, 2013, 65(3): 161-170. 

[77] Modig K K, Godtman R A, Bjartell A, et al. Vesicourethral anastomotic stenosis after open or robot-assisted laparoscopic retropubic prostatectomy-results from the laparoscopic prostatectomy robot open trial[J]. Eur Urol Focus, 2021, 7(2): 317-324. 

[78] Sooriakumaran P, Srivastava A, Shariat S F, et al. A multinational, multi-institutional study comparing positive surgical margin rates among 22 393 open, laparoscopic, and robot-assisted radical prostatectomy patients[J]. Eur Urol, 2014, 66(3): 450-456. 

[79] Rozet F, Harmon J, Cathelineau X, et al. Robot-assisted versus pure laparoscopic radical prostatectomy[J]. World J Urol, 2006, 24(2): 171-179. 

[80] WU S Y, CHANG C L, CHEN C I, et al. Comparison of acute and chronic surgical complications following robot-assisted, laparoscopic, and traditional open radical prostatectomy among men in Taiwan[J]. JAMA Netw Open, 2021, 4(8): e2120156. 

[81] Forsmark A, Gehrman J, Angenete E, et al. Health economic analysis of open and robot-assisted laparoscopic surgery for prostate cancer within the prospective multicentre LAPPRO trial[J]. Eur Urol, 2018, 74(6): 816-824. 

[82] Ploussard G, Grabia A, Barret E, et al. Annual nationwide analysis of costs and post-operative outcomes after radical prostatectomy according to the surgical approach (open, laparoscopic, and robotic) [J]. World J Urol, 2022, 40(2): 419-425. 

[83] SONG C, CHENG L, LI Y L, et al. Systematic literature review of cost-effectiveness analyses of robotic-assisted radical prostatectomy for localised prostate cancer[J]. BMJ Open, 2022, 12(9): e058394. 

[84] FAN S B, ZHANG Z Y, WANG J, et al. Robot-assisted radical prostatectomy using the kangduo surgical robot-01 system: a prospective, single-center, single-arm clinical study[J]. J Urol, 2022, 208(1): 119-127. 

[85] WANG Y, QU M, MEI N, et al. A stageⅢ randomized controlled study of a domestic endoscopic robot usded in radical prostatectomy[J]. Chin J Urol, 2021, 42(7): 485-490.