David M. Albala, MD, presented “Robotic Prostatectomy: How Far Have We Come All These Years?” during the 32nd Annual International Prostate Cancer Update (IPCU32) conference on March 8, 2022, in Snowbird, Utah.
How to cite: Albala, David M. “Robotic Prostatectomy: How Far Have We Come All These Years?” March 8, 2022. Accessed Jan 2026. https://grandroundsinurology.com/robotic-prostatectomy-how-far-have-we-come-all-these-years/
Robotic Prostatectomy: How Far Have We Come All These Years? – Summary
David M. Albala, MD, Chief of Urology at Crouse Hospital in Syracuse, New York, discusses the increasing use of robotic prostatectomy and its effectiveness today. Dr. Albala contextualizes robotics as a universal medical practice starting in 2003. Since then, robotics has increased as a surgical option, with a 21.32% increase from 2012 to 2022. Dr. Albala begins a literature review on the perioperative outcomes of robot-assisted radical prostatectomy (RARP) as compared to open radical retropubic prostatectomy (RRP). Despite not being complication free, RARP has an overall complication rate of less than 5%. Further studies show improved perioperative morbidity, lower complication rate, and lower length of stay for robotic surgery compared to open surgery. Dr. Albala considers the difference between RARP and RRP in respect to positive surgical margins (PSM) and remarks on how robotics improved the understanding of the neurovascular bundle. He shows a study where RARP has lower PSM rates (13.8%) compared to RRP (22.8%). Dr. Albala next considers oncological outcomes, reporting no evidence that robotics results in worse oncological outcomes, even in cases of high-risk prostate cancer. Dr. Albala compares functional outcomes between RARP and RRP. He includes a video of robotic surgery with precise apical dissection. He introduces multiple studies comparing continence and potency rates in RARP versus RRP, where RARP is favored in both. Dr. Albala then presents a use-case of robotics where modified anterior dissection (MAD) with apical preservation shows better functional outcomes than conventional RARP. Dr. Albala outlines the technical modifications and techniques made available by robotics, such as suspension stitch. Dr. Albala touches on the learning curve of robotics but shows techniques used to address this. He concludes by addressing the negative marketing associated with robotics while reassuring that the data is on the side of robotics.
About the 32nd Annual International Prostate Cancer Update (IPCU32):
Presented by Program Chair E. David Crawford, MD, The International Prostate Cancer Update (IPCU), is a multi-day, CME-accredited conference focused on new developments in prostate cancer treatment, diagnosis, and prevention. IPCU 32 featured lectures, interactive discussions, panel roundtables, debates, and case reports. This conference was led by expert physicians and is designed for urologists, medical oncologists, radiation oncologists, and other healthcare professionals involved in the diagnosis and treatment of prostate cancer.
ABOUT THE AUTHOR
David M. Albala, MD, is a Chief of Urology at Crouse Hospital in Syracuse, New York. Dr. Albala is considered a national and international authority in laparoscopic and robotic urological surgery. His clinical interests include minimally invasive treatments for benign prostatic hypertrophy (BPH), the use of fibrin sealants in surgery, and robotic urologic surgery.
Dr. Albala earned his medical degree at Michigan State University in East Lansing. He completed a residency in Surgery at Dartmouth-Hitchcock Medical Center in Lebanon, New Hampshire. He then completed a fellowship in Endourology at Washington University in St. Louis, Missouri. Under the direction of Ralph V. Clayman, Dr. Albala was part of the team that performed the first laparoscopic nephrectomy in humans.
Dr. Albala is a past White House Fellow (1995-1996), who acted as a special assistant to Federico Peña, Secretary of Transportation, on classified and unclassified public health related issues. He has been a visiting professor at numerous institutions across the United States as well as overseas in countries such as India, China, Iceland, Germany, France, Japan, Brazil, Australia, and Singapore. He has done operative demonstrations in over 32 countries and 23 states. Dr. Albala has over 215 publications in peer-reviewed journals and has authored 3 textbooks in endourology and 4 books in general urology. He is currently the Editor-in-Chief of theJournal of Robotic Surgeryand serves on the editorial board forCurrent Opinions in Urology, Reviews in Urology,andUrology Index and Reviews. In addition, he serves as a reviewer for 8 other surgical journals. He is currently on the Board of Directors of the Large Urology Group Practice Association (LUGPA). Dr. Albala is also currently the Visiting Professor of Urology at SUNY Downstate Health Sciences University, College of Medicine. Dr. Albala has been identified (by a Stanford University-led study) as one of the top 2% of scientists in the world.
