Laparoscopic radical prostatectomy is emerging as an alternative to open radical prostatectomy for treating localised prostate cancer. However at the present time there is insufficient comparative data regarding continence, potency and survival. There did not appear to be any clear differences between the laparoscopic approaches.
A clear learning curve for laparoscopic prostatectomy was documented which affected many clinical outcomes. Although it was not possible to determine from the included studies how many laparoscopic procedures must be completed to negotiate this learning curve, the introduction of LRP should be closely monitored. Previous experience in laparoscopy and/or open radical prostatectomy is required and outcomes during the initial phase of the learning curve should be carefully documented.
Recommendations: 1. a national audit of laparoscopic radical prostatectomy, including robotic-assisted LRP, should be instituted to monitor the introduction of the technique into the Australian healthcare system. 2. hospital credentialling committees should monitor the progress of surgeons introducing LRP into their practice at regular intervals, paying particular regard to rates of complications and surgical margins during the learning phase. 3. Economic evaluations taking into consideration the Australian healthcare context should be conducted.