Laparoscopic versus robot-assisted radical prostatectomy: trifecta outcomes in prostate cancer surgery

The trifecta outcome in prostate cancer surgery is a core measure for the assessment of prostatectomy techniques which constitutes oncological control, preservation of urinary continence, and erectile function preservation. Interpretation of trifecta outcomes is complex due to variation in patient selection, definitions, and follow-up protocols. This study aims to compare LRP (laparoscopic radical prostatectomy) and RARP (robot-assisted radical prostatectomy) in the management of prostate cancer, especially trifecta outcomes. A literature search was conducted using PubMed, Embase, and CINAHL databases to identify studies relevant to the topic from 2005 to May 2025. Studies that compared RARP and LRP in prostate cancer patients and reported at least one of the trifecta outcomes were included in this narrative review. Functional outcomes, patient satisfaction, and cost-effectiveness were the different themes for which data was synthesized. Early outcomes in urinary incontinence and erectile function showed better recovery with RARP when compared to LRP, specifically within the first 12 months postoperatively. Within the two approaches, oncological outcomes such as positive surgical margin and biochemical recurrence were comparable. There was reduced postoperative pain, faster recovery, and higher satisfaction scores associated with RARP. However, there are significant barriers to adoption of RARP like high cost and limited access particularly in low- and middle-income countries. The choice between RARP and LRP should be individualized. Further research should focus on integrating AI, AR and ePROMSs to improve surgical care. RARP offers advantages in early functional recovery, while long-term oncological outcomes remain comparable between techniques.