Radical prostatectomy remains a key curative treatment for localized prostate cancer which has undergone continuous transformation. Recent developments in robot-assisted and single-port surgery have followed the concept of minimizing morbidity while maintaining oncologic safety. Furthermore, the integration of artificial intelligence and novel diagnostic tools have transformed the modern surgical workflow. Therefore, the aim of this study is to give an overview of the evolution of surgical techniques, functional and oncological outcomes, and available surgeon-assisting concepts.
We conducted a non-structured review to summarize the evolution of radical prostatectomy techniques and recent developments in surgeon-assisting tools. Relevant English-language publications were identified through a targeted PubMed search using predefined keywords related to, laparoscopic, robot-assisted, Retzius-sparing, and single-port approaches. Key studies, systematic reviews, and meta-analyses were used and synthesized to provide a comparative overview. Furthermore, studies focusing on integration of artificial intelligence, novel diagnostic tools and targeted surgery are discussed.
Laparoscopic surgery aims to reduce morbidity yet is technically demanding. Robotic-assisted approaches improve visualization and precision, leading to faster recovery and earlier continence recovery. Newer Retzius-sparing and single-port techniques show promising functional results, though evidence is still limited. Novel diagnostic tools including image overlay, targeted surgery, and fast and accurate intraoperative pathological assessment of resection margins are increasingly shaping modern radical prostatectomy.
Radical prostatectomy has evolved into a minimally invasive, technology-driven procedure with improved recovery and functional outcomes. Advances in robotics, imaging, and artificial intelligence enhance surgical precision. Ongoing innovation and long-term data will define the future of prostate surgery.
Frontiers in surgery. 2026 Apr 30*** epublish ***
Philipp Nick, Theodoros Tokas, Selçuk Guven, Panagiotis Kallidonis, Eric Barret, Begoña Ballesta Martínez, Moaz F Ismail Abdelrahman, Andrea Gallioli, Udo Nagele, Gernot Ortner
Department of Urology and Andrology, General Hospital Hall I.T., Hall in Tirol, Austria., Department of Urology, University General Hospital of Heraklion, University of Crete, Medical School, Heraklion, Greece., Department of Urology, University of Konya, Konya, Türkiye., Department of Urology, University of Patras, Patras, Greece., Department of Urology, Institute Mutualiste Montsouris, Paris, France., Department of Urology, University Hospital del Vinalopo, Elche, Spain., Department of Urology, East Lancashire Hospitals NHS Trust, Blackburn, United Kingdom., Department of Urology, Puigvert Foundation, Barcelona, Spain.