Robotic Prostatectomy (original) (raw)
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European urology, 2015
Robot-assisted laparoscopic radical prostatectomy has become a widespread technique despite a lack of randomised trials showing its superiority over open radical prostatectomy. To compare in-hospital characteristics and patient-reported outcomes at 3 mo between robot-assisted laparoscopic and open retropubic radical prostatectomy. A prospective, controlled trial was performed of all men who underwent radical prostatectomy at 14 participating centres. Validated patient questionnaires were collected at baseline and after 3 mo by independent health-care researchers. The difference in outcome between the two treatment groups were analysed using logistic regression analysis, with adjustment for identified confounders. Questionnaires were received from 2506 (95%) patients. The robot-assisted surgery group had less perioperative bleeding (185 vs 683ml, p < 0.001) and shorter hospital stay (3.3 vs 4.1 d, p < 0.001) than the open surgery group. Operating time was shorter with the open ...
Update on laparoscopic and robotic radical prostatectomy
Current Opinion in Urology, 2005
Purpose of review Laparoscopic and robotic-assisted prostatectomy have been proposed as alternatives to traditional open retropubic prostatectomy. In this review, we update the more recent data concerning the results, technical trends and controversies regarding these novel, minimally invasive procedures. Recent findings As a result of improved patient selection, a better understanding of surgical anatomy, and refinements in surgical techniques, traditional retropubic prostatectomy set the standards very high, leaving little room for improvement. In this review, the results of laparoscopic prostatectomy are compared with contemporary in addition to historical series. Besides the transperitoneal laparoscopic approach, which was almost exclusively used in the initial series, the introduction and development of the extraperitoneal laparoscopic approach meant a significant change in the surgical strategy of a number of teams worldwide. The relative merits of the transperitoneal and extraperitoneal approaches are discussed. Robotic radical prostatectomy is a promising technical innovation that allows us to overcome many of the inherent limitations of laparoscopic surgery. As a result of financial constraints, the experience has been limited to a few centres worldwide. Summary Although long-term results are still lacking, novel minimally invasive techniques seem to fulfil the highest standards of radical prostatectomy in terms of early oncological cure, functional results and morbidity. A standardization of data collection and evaluation methodology will be indispensable for a better comparison of the different series.
Laparoscopic and Robotic Assisted Radical Prostatectomy – Critical Analysis of the Results
European Urology, 2006
Objective: To evaluate the role of laparoscopic radical prostatectomy (LRP) and robotic assisted radical prostatectomy (RLRP) based on personal experience and a review of the literature. Material and methods: Own experience at one European and one American LRP-center includes more than 2000 cases. We performed a MED-LINE search reviewing the literature on LRP and RLRP between 1992 and 2005 with special emphasis on historical aspects, technical considerations, comparison to open retropubic (RRP) and perineal radical prostatectomy (PRP), laparoscopic training, and the cost-efficiency of the techniques. Results: Based on sophisticated training programs a continuous dissemination of the technique took place. In the United States, this process was accelerated by the use of the daVinci 1-robot. There is a trend towards the extraperitoneal access. Mid-term outcomes of LRP achieved equivalence to open surgery with regards to complications, oncologic and functional results. Distinct advantages of LRP include less postoperative pain, lower rate of complications, shorter convalescence, and better cosmesis. In contrast to RLRP, LRP may reach cost-equivalence with open surgery (i.e. by reduction of OR-time, use of multi-usable instruments). Conclusions: LRP reproduces the excellent results of open surgery providing the advantages of minimal access. Video-assisted teaching improves the transfer of anatomical knowledge and technical knowhow. In contrast the United States, the use of robots is likely to remain limited in Europe.
Best Evidence Regarding the Superiority or Inferiority of Robot-Assisted Radical Prostatectomy
Urologic Clinics of North America, 2014
Oncologic outcomes are generally excellent for both robotic-assisted laparoscopic radical prostatectomy (RALP) and radical retropubic prostatectomy (RRP), with no consistent oncologic outcome difference. Studies consistently report significantly lesser blood loss with RALP than RRP, and many report lower prolonged duration of stay and bladder neck contracture rates. In expert hands, urinary incontinence and potency outcomes are similar between RALP and RRP. Ultimately, the skill and experience of the surgeon remain the greatest determinant of surgical outcomes after RALP and RRP.
ROBOT-ASSISTED VERSUS OPEN RADICAL PROSTATECTOMY: A COMPARISON OF ONE SURGEON'S OUTCOMES
2004
Objectives. To compare internally one surgeon's standard open radical prostatectomy (RP) and robotassisted laparoscopic RP (RLP) results. RLP, like standard laparoscopic RP, ultimately needs to produce similar or improved results compared with standard RP techniques. Little information comparing RLP with standard RP exists. Methods. As an internal control, we selected the last 60 standard RPs performed by one surgeon (T.A.) before initiating RLPs. For the RLP group, we selected cases 46 to 105 (n ϭ 60) after the learning curve had adequately matured. We compared the clinical characteristics, perioperative results, and early clinical outcomes.
Prostate Cancer, 2011
Objective. We sought to compare positive surgical margin rates (PSM), estimated blood loss (EBL), and quality of life outcomes (QOL) among perineal (RPP), retropubic (RRP), and robot-assisted laparoscopic (RALP) prostatectomies.Methods. Records from 463 consecutive men undergoing RPP (92), RRP (180), or RALP (191) for clinically localized prostate cancer were retrospectively reviewed. Age, percent tumor volume, Gleason score, stage, EBL, PSM, and QOL using the expanded prostate cancer index composite (EPIC) were compared.Results. PSM were similar when adjusted for stage, grade, and volume. EBL was significantly less in the RALP (189 ml) group compared to both RPP (475 ml) and RRP (999 ml) groups. When corrected for nerve sparing, there were no differences in erectile function and sexual function amongst the three groups. Urinary summary and pad usage scores showed no significant differences.Conclusion. RPP, RRP, and RALP offer similar surgical and QOL outcomes. RALP and RPP demonstr...
Robotic-assisted Laparoscopic Prostatectomy: Initial Experience of 267 Cases
Üroonkoloji bülteni, 2019
To present our experience of 267 consecutive patients treated with robotic-assisted laparoscopic prostatectomy (RALP) and assess the perioperative and postoperative outcomes. Materials and Methods: We retrospectively analyzed the data of 267 men who underwent RALP in our clinic between March 2015 and April 2018. Preoperative clinical data including age, serum prostate-specific antigen (PSA), biopsy Gleason score, and number of positive cores were noted. Perioperative parameters such as operative time and intraoperative complications were recorded. Postoperative parameters including hematocrit change, length of hospital stay, and catheter removal date were noted. Pathological outcomes included pathological Gleason score; positive surgical margin (PSM) status; extracapsular, lymphovascular, perineural, and seminal vesicle invasion; and lymph node positivity. The Clavien-Dindo system was used to classify surgical complications. Results: The mean age of the patients was 64.2±6.4 years and the median PSA was 8.27 ng/dL. The mean operative time was 196.4±59.4 min and median hematocrit decrease was 3.9%. The overall PSM rate was 21.34% and this rate increased significantly with final pathological stage from 12.97% for pT2 to 35.48% for pT3 (p<0.05). Over a mean follow-up time of 19 months, biochemical recurrence occured in 29 patients (9.7%) and a total of 35 patients (22%) required additional treatment. A total of 29 patients (10.86%) had complications and 1 patient required surgical intervention in the first 48 hours after surgery. The median postoperative hospital stay was 3 days and median time to urethral catheter removal was 10 days. Conclusion: Our initial experience with RALP is promising. Oncological outcomes were satisfactory, with patients benefiting from the advantages of the minimally invasive surgical approach.
Downsides of Robot-assisted Laparoscopic Radical Prostatectomy: Limitations and Complications
European Urology, 2010
E U R O P E A N U R O L O G Y X X X ( 2 0 0 9 ) X X X -X X X a v a i l a b l e a t w w w . s c i e n c e d i r e c t . c o m j o u r n a l h o m e p a g e : w w w . e u r o p e a n u r o l o g y . c o m Abstract Context: Robot-assisted laparoscopic radical prostatectomy (RALP) using the da Vinci Surgical System (Intuitive Surgical, Sunnyvale, CA, USA) is now in widespread use for the management of localised prostate cancer (PCa). Many reports of the safety and efficacy of this procedure have been published. However, there are few specific reports of the limitations and complications of RALP. Objective: The primary purpose of this review is to ascertain the downsides of RALP by focusing on complications and limitations of this approach. Evidence acquisition: A Medline search of the English-language literature was performed to identify all papers published since 2001 relating to RALP. Papers providing data on technical failures, complications, learning curve, or other downsides of RALP were considered. Of 412 papers identified, 68 were selected for review based on their relevance to the objective of this paper. Evidence synthesis: RALP has the following principal downsides: (1) device failure occurs in 0.2-0.4% of cases; (2) assessment of functional outcome is unsatisfactory because of nonstandardised assessment techniques; (3) overall complication rates of RALP are low, although higher rates are noted when complications are reported using a standardised system; (4) long-term oncologic data and data on high-risk PCa are limited; (5) a steep learning curve exists, and although acceptable operative times can be achieved in <20 cases, positive surgical margin (PSM) rates may require experience with >80 cases before a plateau is achieved; (6) robotic assistance does not reduce the difficulty associated with obese patients and those with large prostates, middle lobes, or previous surgery, in whom outcomes are less satisfactory than in patients without such factors; (7) economic barriers prevent uniform dissemination of robotic technology. Conclusions: Many of the downsides of RALP identified in this paper can be addressed with longer-term data and more widespread adoption of standardised reporting measures. The significant learning curve should not be understated, and the expense of this technology continues to restrict access for many patients.
Turkish Journal of Medical Sciences, 2011
We report our initial experience related with robot-assisted laparoscopic radical prostatectomy (RALRP) performed by a urologic surgeon without previous laparoscopic radical prostatectomy (LRP) experience. Materials and methods: The data of the first 70 patients who underwent RALRP between February 2009 and February 2010 are presented. Results: Mean console time was 214 ± 55.5 min with pelvic lymph node dissection (LND) in 14 patients. Mean intraoperative blood loss was 215 ± 227.3 cc. Fourteen patients had positive surgical margins: pT3 (n = 12) and pT2 (n = 2). Lodge drains and urethral catheters were removed at a mean of 2.9 ± 2.7 and 11.6 ± 5.9 days, respectively. Forty-three of 58 patients (82.9%) had urinary control at the 3-month follow-up. Regarding the patients with preoperative IIEF scores >= 19 (mean: 47.6 ± 17.0, n = 46), mean IIEF score was 45.3 ± 9.9 (n = 11) at the 9-month follow-up. Regarding patients with preoperative IIEF scores of 13-18 (mean: 16.3 ± 1.1, n = 6...
European Urology, 2009
Background: Robotic-assisted laparoscopic radical prostatectomy (RALP) using the da Vinci 1 surgical system (Intuitive Surgical, Sunnyvale, CA) is increasingly used for the management of localised prostate cancer. Objective: We report the operative details and short-term oncological and functional outcome of the first 400 RALPs performed at our unit. Design, setting and participants: From December 2003 to August 2006, 400 consecutive patients underwent RALP at our institution. A prospective database was established to record the relevant details of all RALP cases. Surgical procedure: A six port transperitoneal approach using a 4-arm da Vinci 1 system was used to perform RALP. This database was reviewed to establish the operative details and oncological and functional outcome of all patients with a minimum of 12 months follow-up. Measurements: Perioperative characteristics and outcomes are reported. Functional outcome was assessed using continence and erectile function questionnaires. Biochemical recurrence (prostate-specific antigen (PSA) !0.2 ng/mL) is used as a surrogate for cancer control. Results and limitations: The mean age AE standard deviation (SD) was 60.2 AE 6 years. Median PSA level was 7.0 (interquartile range (IQR) 5.3-9.6) ng/mL. The mean operating time AE SD was 186 AE 49 mins. The complication rate was 15.75% comprising Clavien grade I-II and Clavien grade III complications in 10.5% and 5.25% of patients respectively. The overall positive surgical margin rate was 19.2% with T2 and T3 positive margin rates of 9.6% and 42.3% respectively. The biochemical recurrence-free survival was 86.6% at a median follow-up of 22 (IQR = 15-30) months. At 12 months follow-up, 91.4% of patients were pad-free or used a security liner. Of those men previously potent (defined as Sexual Health Inventory for Men [SHIM] score !21) who underwent nerve-sparing RALP, 62% were potent at 12 months. Conclusions: The safety and feasibility of RALP has already been established. Our initial experience with this procedure shows promising short-term outcomes.