A Direct Comparison of Robotic Assisted Versus Pure Laparoscopic Radical Prostatectomy: A Single Institution Experience
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Abstract
Purpose:
We compared a single institution experience with radical prostatectomy using a pure laparoscopic technique vs a robotically assisted technique with regard to preoperative, intraoperative or postoperative parameters.
Materials and Methods:
From May 2003 to May 2005 we reviewed 133 consecutive patients who underwent extraperitoneal robot assisted radical prostatectomy and compared them to 133 match-paired patients treated with a pure extraperitoneal laparoscopic approach. The patients were matched for age, body mass index, previous abdominopelvic surgery, American Society of Anesthesiologists score, prostate specific antigen, pathological stage and Gleason score. Preoperative, perioperative and postoperative data, including complications and oncological results, were analyzed between the 2 groups.
Results:
The 2 groups were statistically similar with respect to age, body mass index, prostate specific antigen, Gleason score and clinical stage. No statistical differences were observed regarding operative time, estimated blood loss, hospital stay or bladder catheterization between the 2 groups. The transfusion rate was 3% and 9.8% for laparoscopic radical prostatectomy and robotic assisted laparoscopic prostatectomy, respectively (p = 0.03). Conversion from robotic assisted laparoscopic prostatectomy to laparoscopic radical prostatectomy was necessary in 4 cases. None of the laparoscopic radical prostatectomy cases required conversion to an open technique. The percentage of major complications was 6.0% vs 6.8%, respectively (p = 0.80). The overall positive margin rate was 15.8% vs 19.5% for laparoscopic radical prostatectomy and robotic assisted laparoscopic prostatectomy, respectively (p = 0.43).
Conclusions:
We demonstrated that the laparoscopic extraperitoneal radical prostatectomy is equivalent to the robotic assisted laparoscopic prostatectomy in the hands of skilled laparoscopic urological surgeons at our institution with respect to operative time, operative blood loss, hospital stay, length of bladder catheterization and positive margin rate.
References
- 1 : Laparoscopic radical prostatectomy: initial short-term experience. Urology1997; 50: 854. Google Scholar
- 2 : Initial experience with extraperitoneal endoscopic radical retropubic prostatectomy. Urology1997; 50: 849. Google Scholar
- 3 : Laparoscopic radical prostatectomy: technical and early oncological assessment of 40 operations. Eur Urol1999; 36: 14. Google Scholar
- 4 : Open versus laparoscopic radical prostatectomy: part I. BJU Int2004; 94: 238. Google Scholar
- 5 : Prospective comparison of short-term convalescence: laparoscopic radical prostatectomy versus open radical retropubic prostatectomy. Urology2003; 61: 612. Google Scholar
- 6 : Vattikuti Institute prostatectomy: technique. J Urol2003; 169: 2289. Link, Google Scholar
- 7 : Extraperitoneal standard laparoscopic radical prostatectomy. J Endourol2004; 18: 605. Google Scholar
- 8 : Biochemical outcome after radical prostatectomy, external beam radiation therapy, or interstitial radiation therapy for clinically localized prostate cancer. JAMA1998; 280: 969. Google Scholar
- 9 : Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg2004; 240: 205. Google Scholar
- 10 : Laparoscopic radical prostatectomy. J Urol2005; 173: 1072. Link, Google Scholar
- 11 : Laparoscopic radical prostatectomy: assessment after 240 procedures. Urol Clin North Am2001; 28: 189. Google Scholar
- 12 : Laparoscopic extraperitoneal radical prostatectomy–learning curve of a laparoscopy-naive urologist in acommunity hospital. Urology2005; 65: 959. Google Scholar
- 13 : An operative and anatomic study to help in nerve sparing during laparoscopic and robotic radical prostatectomy. Eur Urol2003; 43: 444. Google Scholar
- 14 : Successful transfer of open surgical skills to a laparoscopic environment using a robotic interface: initial experience with laparoscopic radical prostatectomy. J Urol2003; 170: 1738. Link, Google Scholar
- 15 : Laparoscopic and robot assisted radical prostatectomy: establishment of a structured program and preliminary analysis of outcomes. J Urol2002; 168: 945. Link, Google Scholar
- 16 : Laparoscopic radical prostatectomy: conventional and robotic. Urology2005; 66: 101. Google Scholar
- 17 : Robot-assisted vs pure laparoscopic radical prostatectomy: are there any differences?. BJU Int2005; 96: 39. Google Scholar
- 18 : Radical prostatectomy by the retropubic, perineal and laparoscopic approach: 12 years of experience in one center. Eur Urol2002; 42: 104. Google Scholar
- 19 : The new economics of radical prostatectomy: cost comparison of open, laparoscopic and robot assisted techniques. J Urol2004; 172: 1431. Link, Google Scholar
Department of Urology, Institut Montsouris, Paris, France
