Robotic radical prostatectomy: evolution from conventional to VIP

Following the popularization of Vattikuti Institute Prostatectomy technique of robotic radical prostatectomy (RARP) by Menon et al., RARP has been gaining steady acceptance as a preferred alternative to both open and laparoscopic radical prostatectomy (LRP). Up until now, radical retropubic prostatectomy has been considered the gold standard for treatment of organ confined prostate cancer. Despite significant improvements in intraoperative blood loss and functional outcomes, driven primarily by the description of anatomical radical prostatectomy by Walsh, the perioperative morbidity, analgesic requirement, and recovery times have remained disadvantages of the open approach. LRP has been unable to gain widespread acceptance because of technical difficulty and a steep learning curve. The da Vinci assisted approach incorporates the advantages of minimally invasive approach while improving upon the results of the open approach. This paper traces the evolution of RARP and describes technical modifications incorporated at the Vattikuti Urology Institute including operative data, complications, and functional outcomes.