Among the treatment options for prostate cancer (PCa), minimally invasive surgery has gained widespread popularity in recent decades. The objective of this prospective randomized study by Fiori et al., was to present oncologic, functional, and qualitative data after 10 years of follow-up comparing robotic versus laparoscopic radical prostatectomy for the treatment of prostate cancer.

At 10 years, the ICIQ-SF (incontinence questionnaire) showed a significantly higher percentage of fully continous patients in the robotic group with greater urinary loss in the laparoscopic group.

A similar trend to continence was observed for recovery of erectile function in patients undergoing neuroprotective robotic prostatectomy.

No differences were observed between the two groups in oncological outcomes.

The impact of the surgical technique on long-term results is mainly reflected in the first years after the intervention. For the first time, a prospective randomized controlled trial finds significant advantages for robotic radical prostatectomy over laparoscopic in terms of continence and recovery of erectile function in the first 5 years of follow-up.

The robotic approach, with the improved visualization and maneuverability of the robotic tools, allows for more precise preservation, reducing erectile nerve damage, resulting in a faster and higher rate of recovery of erectile function.

In favor of the robotic approach at the end of the follow-up a difference of 12% was found for continence and 8% for erectile capacity.

Analysis of the quality of continence (amount of urine loss and percentage of fully continous patients) with the ICIQ-SF questionnaire and the quality of erections with the IIEF-5 questionnaire, it was found that in the robotic group, patients presented better results.

Oncological outcomes were comparable between the two surgical techniques.

Regarding safety outcomes and late postoperative complications, both approaches resulted in a low rate of adverse events, which is in agreement with a previous population-based study by Wu.et al, where it was found that robotics was associated with fewer acute and chronic postoperative complications than open or laparoscopic.

All of the aforementioned factors (both functional and oncological) translate into extremely satisfying long-term results.

However, faster recovery of continence and erectile function with the robotic platform led to higher satisfaction with robotic radical prostatectomy.

In conclusion, therefore, in 10 years of follow-up, robotic radical prostatectomy compared to laparoscopic recorded a higher percentage of patients who achieved total continence and the appearance of quality and effective erections.