Robot-assisted vs pure laparoscopic radical prostatectomy: Are there any differences?
University of Rochester, Rochester, New York, United States BJU International
(Impact Factor: 3.53).
08/2005; 96(1):39-42. DOI: 10.1111/j.1464-410X.2005.05563.x
To compare our experience of pure laparoscopic radical prostatectomy (LRP) with robot-assisted radical prostatectomy (RAP).
The two techniques were compared retrospectively in 100 patients with localized prostate cancer who had LRP or RAP (50 each). Both groups were similar in age, serum prostate-specific antigen level, Gleason score and clinical stage. Their charts were reviewed, collating intraoperative data and early functional outcome.
The mean surgical time for LRP and RAP was 235 and 202 min (P > 0.05) and mean (95% confidence interval) blood loss 299 (40) and 206 (63) mL (P = 0.014), with no transfusions in either group. The positive margin rate did not differ significantly (14% LRP and 12% RAP) and there was no biochemical recurrence in either group. Early functional outcomes were similar.
Both LRP and RAP are technically demanding, but feasible, with the patient clearly benefiting. There were no major surgical differences between the techniques, but RAP is more costly.
Available from: Takehiko Okamura
- "At present there are several definitive surgical options for managing clinically localized prostate cancer, including radical retropubic prostatectomy (RRP), laparoscopic RP (LRP), and robot-assisted RP (RALP). Nowadays, robotic-assisted laparoscopic radical prostatectomy (RALP) is spreading worldwide (Menon et al., 2004; Joseph et al., 2005; Rozet et al., 2007; Hakimi et al., 2009). However, RALP needs five to seven ports and one 4-5cm wound is necessary. "
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While 5-port laparoendoscopic radical prostatectomy is standard practice, efforts have been focused in developing a single port surgery for cosmetic reasons. However, this is still in the pioneering stage considering the challenging nature of the surgical procedures. We have therefore focused on reduced port surgery, using only 2-ports. In this study, we compared 2-port laparoendoscopic radical prostatectomy (2-port RP) and conventional 5-port laparoscopic radical prostatectomy (LRP) for clinically localized prostate carcinoma and evaluated the potential advantages of each.
Materials and methods:
From January 2010 to December 2010, all 23 patients with clinically localized prostate cancer underwent LRP. Starting November, 2010, when we introduced the reduced port approach, we performed this procedure for 22 consecutive patients diagnosed with early-stage prostate cancer (cT1c, cT2N0). The patients were matched 1:1 to 2-port RP or LRP for age, preoperative serum PSA level, clinical stage, biopsy and pathological Gleason grade, surgical margin status, pad-free rates and post-operative pain.
There was a significant difference in operative time between the 2-port RP and LRP groups (286.5 ± 63.3 and 351.8 ± 72.4 min: p=0.0019, without any variation in blood loss (including urine) (945.1 ± 479.6 vs 1271.1 ± 871.8 ml: p=0.13). The Foley catheter indwelling period was shorter in the 2 port RP group, but without significance (5.6 ± 1.8 vs 8.0 ± 5.6 days: p=0.057) and the total perioperative complication rates for 2 port RP and LRP were comparable at 4.5% and 8.7% (p=0.58). There was an improvement in pad-free rates up to 6 months follow-up (p=0.090), and significantly improvement at 1 year (p=0.040). PSA recurrence was 1 (4.5%) in 2-port RP and 2 (8.7%) in LRP. Continuous epidural anesthesia was used in most of LRP patients (95.7%) and in early 2-port RP patients (40.9%). In these patients, average total amount of Diclofenac sodium was 27.8 mg/patient in 2-port RP and 50.0mg/patient in LRP.
Thus the reduced port approach is as efficacious as LRP in terms of many outcome measures, with significant cosmetic advantages and reduction in post surgical pain. This method can be readily performed safely and therefore can be recommended as a standard laparoscopic surgery for prostate cancer in the future.
Available from: Kevin O'Shaughnessy
- "Urinary and bowel problems Joseph et al. (2005) found little difference in urinary and bowels problems between surgical modalities. It is unclear in our study, why men undergoing RALP appeared to have fewer such problems. "
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To compare patient reported outcomes between robotic assisted surgery and non-robotic assisted surgery.
This was an international web-based survey based on a qualitative research and literature review, an internet-based questionnaire was developed with approximately 70 items. The questionnaire included both closed and open-ended questions.
Responses were received from 193 men of whom 86 had received either open (OP) or robotic (RALP) surgery. A statistically significant (p=0.027), ranked analysis of covariance was found demonstrating higher recent distress in the robotic (RALP) surgery group. Although not statistically significant, there was a pattern of men having robotic (RALP) surgery reporting fewer urinary and bowel problems, but having a greater rate of sexual dysfunction.
Men who opt for robotic surgery may have higher expectations for robotic (RALP) surgery, when these expectations are not fully met they may be less likely to accept the consequences of this major cancer surgery. Information regarding surgical choice needs to be tailored to ensure that men diagnosed with prostate cancer are fully informed of not only short term surgical and physical outcomes such as erectile dysfunction and incontinence, but also of potential issues with regards to masculinity, lifestyle and sexual health.
Available from: europepmc.org
- "In previous studies that compared ORP with LRP or RARP, the rate of occurrence of BNC from LRP or RARP was reported to be lower than that from ORP [8,9,18]. The magnification of visualization and excellent movement of the device inside the narrow pelvic cavity in LRP and RARP enables the surgeon to more easily and effectively conduct VUA, and the running suture technique for VUA could be helpful for decreasing the rate of urinary leakage. "
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ABSTRACT: To evaluate the prevalence of bladder neck contracture (BNC) and its risk factors in patients undergoing radical prostatectomy in Korea.
We analyzed data from 488 patients with prostatic cancer who underwent radical prostatectomy performed by seven surgeons in seven hospitals, including 365 open radical prostatectomies (ORPs), 99 laparoscopic radical prostatectomies (LRPs), and 24 robot-assisted laparoscopic radical prostatectomies (RARPs). Patients with BNCs were compared with those without BNCs to identify the risk factors for BNC occurrence.
Overall, BNCs occurred in 21 of 488 patients (4.3%): 17 patients (4.7%) who underwent ORP, 4 patients (4%) who underwent LRP, and no patients who underwent RARP. In the univariate analysis, men with BNCs had a longer length of time before drain removal (12 days vs. 6.8 days, p<0.001), which reflected urinary leakage through the vesicourethral anastomosis. In the multivariate analysis, the length of time before drain removal was the only predictor of BNC (odds ratio, 1.12; p=0.001). Intraoperative blood loss was higher in patients with BNC, but the difference was not statistically significant.
The most significant factor related to BNC occurrence after radical prostatectomy in our study was the length of time before drain removal, which reflects urinary leakage from the vesicourethral anastomosis. The proper formation of a watertight anastomosis to decrease urinary leakage may help to reduce the occurrence of BNC.
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