Overcoming the challenges of robot-assisted radical prostatectomy (original) (raw)
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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.
Advances in Robotic-Assisted Radical Prostatectomy over Time
Prostate cancer, 2013
Since the introduction of robot-assisted radical prostatectomy (RALP), robotics has become increasingly more commonplace in the armamentarium of the urologic surgeon. Robotic utilization has exploded across surgical disciplines well beyond the fields of urology and prostate surgery. The literature detailing technical steps, comparison of large surgical series, and even robotically focused randomized control trials are available for review. RALP, the first robot-assisted surgical procedure to achieve widespread use, has recently become the primary approach for the surgical management of localized prostate cancer. As a result, surgeons are constantly trying to refine and improve upon current technical aspects of the operation. Recent areas of published modifications include bladder neck anastomosis and reconstruction, bladder drainage, nerve sparing approaches and techniques, and perioperative and postoperative management including penile rehabilitation. In this review, we summarize r...
Robotic assisted radical prostatectomy: surgical techniques and outcomes
International braz j urol, 2007
Robotic assisted radical prostatectomy (RARP) is gaining acceptance and popularity among urologists all over the world. Early oncologic and functional results are encouraging. In this manuscript, we describe in detail both approaches for RARP and show the results of the robotic surgery program with over 300 RARP performed at our institution.
Robot-Assisted Laparoscopic Radical Prostatectomy: Perioperative Outcomes of 1500 Cases
Journal of Endourology, 2008
We have carried out over 360 cases of robot-assisted laparoscopic radical prostatectomy (RARP) to date. In the present study, we detail our current technique at Yonsei University College of Medicine. The six-port transperitoneal approach is utilized. The most lateral two ports were placed medially and caudally in patients with a small pelvis to avoid interference between the ports and the pelvis (modified port configuration). Lymph node dissection is carried out in the external iliac, obturator and infraobturator area. The dissection on the lateral border of the bladder neck is carried out until it reaches the seminal vesicle (ultradissection). After transection of the bladder neck, vasa seminal vesicles are dissected further. Neurovascular bundles are preserved in selected patients. The dorsal venous complex (DVC) and the urethra are transected without suturing. Urethrovesical anastomosis is carried out with 3-0 monocryl running suture, incorporating with the edge of DVC. The puboprostatic collar and bladder are incorporated by 3-0 monocryl running suture (puboperineoplasty). Between November 2007 and September 2008, RARP was carried out using this technique in 182 patients. Median height, weight, body mass index and prostate-specific antigen (PSA) were 168 cm, 68 kg, 24 kg/M 2 and 7.1 ng/mL, respectively. Mean operative time was 192 min and average blood loss was 250 mL. Median catheterization time was 8 days. Positive surgical margin rates for pT2, pT3 and pT4 disease was 12.7, 48 and 100%, respectively. Intraoperative complication rate was 2.7%. Fifty-five patients completed a minimum of 10 months follow up. Their continence rate was 91%. RARP is a safe and feasible surgical modality for prostate cancer among Asian patients with a small pelvis. Our technique achieves a precise bladder neck dissection.
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...
Robotic-assisted laparoscopic radical prostatectomy: a report of the current state
Expert Review of Anticancer Therapy, 2007
Cancer of the prostate is the most common malignancy diagnosed in the male genitourinary tract. Although a number of treatment options are available for early prostate cancer, the gold standard of treatment remains retropubic radical prostatectomy (RRP). However, robotic-assisted laparoscopic radical prostatectomy (RALP) has become a forerunner in treatment options, yielding comparable medium-term perioperative and functional outcomes. For this our team utilized MEDLINE searching for publications on perioperative and functional outcomes related to robotic prostatectomy. Robotic-assisted prostatectomy has allowed urologists to enter the realm of minimally invasive surgery by incorporating open surgery manoeuvres to a laparoscopic environment. To date RALP perioperative and func-tional outcomes are comparable to the gold standard. Collection of long-term data is needed in order to establish its true efficacy.
Robotic-Assisted Laparoscopic Radical Prostatectomy
New Technologies in Urology, 2010
Cancer of the prostate is the most common malignancy diagnosed in the male genitourinary tract. Although a number of treatment options are available for early prostate cancer, the gold standard of treatment remains retropubic radical prostatectomy (RRP). However, robotic-assisted laparoscopic radical prostatectomy (RALP) has become a forerunner in treatment options, yielding comparable medium-term perioperative and functional outcomes. For this our team utilized MEDLINE searching for publications on perioperative and functional outcomes related to robotic prostatectomy. Robotic-assisted prostatectomy has allowed urologists to enter the realm of minimally invasive surgery by incorporating open surgery manoeuvres to a laparoscopic environment. To date RALP perioperative and func-tional outcomes are comparable to the gold standard. Collection of long-term data is needed in order to establish its true efficacy.
Robotic-assisted radical prostatectomy after the first decade: surgical evolution or new paradigm
ISRN urology, 2013
Early studies indicate that robotic-assisted radical prostatectomy (RARP) has promising short-term outcomes; however, RARP is beyond its infancy, and the long-term report cards are now beginning. The important paradigm shift introduced by RARP is the reevaluation of the entire open radical prostatectomy experience in surgical technique by minimizing blood loss and complications, maximizing cancer free outcomes, and a renewed assault in preserving quality of life outcomes by many novel mechanisms. RARP provides a new technical "canvas" for surgical masters to create upon, and in ten years, has reinvigorated a 100-year-old "gold standard" surgery.