Robot assisted laparoscopic prostatectomy: initial tips and tricks.

Robot assisted laparoscopic prostatectomy (RALP) has become a widely accepted and applied surgical method of localized prostate cancer treatment. Initial studies suggest a shorter learning curve for RALP when compared to conventional laparoscopic prostatectomy. Although dexterity for the RALP procedure is increased by the da Vinci surgical robotic system compared to laparoscopic approaches, the anatomical and technical approaches to prostatectomy still require considerable experience in anatomical variations to become proficient and improve oncological and surgical approaches. Several aspects with respect to that can be recognized in the early phases of training. The following aspects helped the author in his initial 150 cases to improve surgical skills: use intraoperative transrectal ultrasound for bladder neck recognition, record and review surgical procedures, experiment with port positioning, training of table assistance. The more recent da Vinci surgical robot systems allow for new dimensions in surgical approaches with particular intraoperative imaging modalities not earlier so easy accessible during surgery. These properties render robot procedures appealing for the now-a-days more and more image-guided approach to surgery.