A prospective comparative analysis of robot‐assisted vs open simple prostatectomy for benign prostatic hyperplasia

Mourmouris, Panagiotis; Keskin, Selcuk M.; Skolarikos, Andreas; Argun, Ömer Burak; Karagiannis, A.; Tüfek, İlter; Öbek, Can; Kural, Ali Rıza

doi:10.1111/bju.14531

Cited by 41 publications

(33 citation statements)

References 26 publications

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“…In line with existing studies, Mourmouris and co-workers reported of a longer operative time, shorter hospital stay and lower estimated blood loss for RASP patients. In this prospective comparative trial, a higher rate of grade ≥ 2 Clavien-Dindo complications in the OSP group could be observed [12]. Interestingly, the number of postoperative blood transfusions in our OSP cohort is higher than the one described in the literature (6.8-13%) [3,18,19].…”

Section: Discussioncontrasting

confidence: 44%

“…In the prospective multicenter trial, Mourmouris et al reported also a transperitoneal approach. For enucleation, a vertical incision of the bladder and prostatic capsule was performed [12]. In contrast, we performed a transvesical approach to the adenoma without dropping the bladder off the pelvic wall in a transperitoneal approach, thus avoiding capsulotomy.…”

Section: Discussionmentioning

confidence: 99%

“…In a larger retrospective study, propensity score-matched cohorts of 59 OSP patients and 59 RASP patients were compared [11]. In the only prospective comparative trial available, Mourmouris et al compared 15 OSP patients and 26 RASP patients in a non-randomized multi-center study [12]. In view of the gap of sufficient data, RASP has investigational status in the current guidelines of the European Association of Urology (EAU) [1].…”

Section: Introductionmentioning

confidence: 99%

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Robot-assisted simple prostatectomy versus open simple prostatectomy: a single-center comparison

et al. 2020

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Purpose Open simple prostatectomy (OSP) is a standard surgical technique for patients with benign prostatic hyperplasia with prostate size larger than 80 ml. As a minimally invasive approach, robot-assisted simple prostatectomy (RASP) emerged as a feasible surgical alternative. Currently, there are no definite recommendations for the standard use of RASP. Therefore, we aimed at investigating various clinical outcomes comparing RASP with OSP. Methods In this retrospective single-center study, we evaluated clinical data from 103 RASP and 31 OSP patients. Both cohorts were compared regarding different clinical characteristics with and without propensity score matching. To detect independent predictive factors for clinical outcomes, multivariate logistic regression analysis was performed. Results Robot-assisted simple prostatectomy patients demonstrated a lower estimated blood loss and need for postoperative blood transfusions as well as less postoperative complications. OSP had a shorter operative time (125 min vs. 182 min) longer hospital stay (11 days vs. 9 days) and longer time to catheter removal (8 days vs. 6 days). In the multivariate analysis, RASP was identified as an independent predictor for longer operative time, lower estimated blood loss, shorter length of hospital stay, shorter time to catheter removal, less postoperative complications and blood transfusions. Conclusion Robot-assisted simple prostatectomy is a safe alternative to OSP with less perioperative and postoperative morbidity. Whether OSP (shorter operative time) or RASP (shorter length of hospital stay) has a more favorable economic impact depends on the particular conditions of different health care systems. Further prospective comparative research is warranted to define the value of RASP in the current surgical management of benign prostatic hyperplasia.

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Section: Discussioncontrasting

confidence: 44%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Robot-assisted simple prostatectomy versus open simple prostatectomy: a single-center comparison

et al. 2020

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“…There are four studies comparing RASP outcomes to OSP [36,[42][43][44][45] (Table 2). In all of these studies, the length of operation was significantly longer in RASP compared to OSP.…”

Section: Resultsmentioning

confidence: 99%

“…All 26 case studies [ 3 , 10 , 12 , 13 , 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 ] included in the final analysis were non comparative case series with level 3 evidence. In nine comparative studies [ 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 ], outcomes of RASP were compared to outcomes of other minimally invasive modalities (OSP, HoLEP, ThuVEP) for the treatment of benign prostate hyperplasia (BPH). Unfortunately, there have been no randomized clinical trials among these studies conducted to date.…”

Section: Resultsmentioning

confidence: 99%

Robotic-Assisted Simple Prostatectomy: A Systematic Review

Kordan

Canda

Köseoğlu

et al. 2020

JCM

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Contemporary minimally invasive surgical (MIS) treatment options of patients with male Lower Urinary Tract Symptoms (LUTS) in men with prostate glands >80 mL include Holmium Laser Enucleation Prostate (HoLEP), Thulium laser VapoEnucleation Prostate (ThuVEP), and Laparoscopic (LSP) or Robotic-Assisted Simple Prostatectomy (RASP). Implementing new laser technologies is costly, and the steep learning curve of these laser techniques limit their wide range use. This promoted the use of LSP and RASP in centers with readily established laparoscopy or robotic surgery programs. The aim of this study is to review case and comparative series of RASP. We systematically reviewed published data from 2008 to 2020 on RASP and have identified 26 non-comparative and 9 comparative case series. RASP has longer operation time but less time spent in hospital and less blood loss. The outcomes of improvements in symptom score, post-voiding residual urine (PVR), postoperative PSA decline, complications, and cost are similar when compared to open and laser enucleation techniques. These outcomes position RASP as a viable MIS treatment option for patients with male LUTS needing surgical treatment for enlarged prostates. Nevertheless, prospective, randomized controlled trials (RCTs) with multicenter and large sample size are needed to confirm the findings of this systematic review.

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Outcomes of robotic modified Freyer's prostatectomy in an Australian patient cohort

et al. 2023

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IntroductionThe study aims to demonstrate the feasibility, safety and efficacy of robotic simple prostatectomy (RSP) using the modified Freyer's approach in an Australian patient cohort. Although RSP is performed in several Australian centres, there is a paucity of published Australian data.MethodsWe reviewed prospectively collected perioperative and outcomes data for patients who underwent a robotic modified Freyer's prostatectomy (RMFP) from June 2019 to March 2022. Statistics were completed using SPSS statistics v27.0 and reported as mean and range with a p value of <0.05 considered statistically significant.ResultsThere were 27 patients who underwent RMFP over the study period with a mean age of 67 years and prostate volume of 159.74 cc (100–275). The mean console time was 168 min (122–211), blood loss of 233 ml (50–600) and average length of hospital stay of 3.8 days (3–8). The preoperative versus postoperative outcome means were as follows: serum prostate‐specific antigen was 9.69 versus 1.2 ng/mL, IPPS score was 17.1 versus 1.25, quality of life (QOL) score 3.4 versus 0.4, postvoid residual volume: 223.6 versus 55.9 ml, Q‐max 7.86 versus 29.6 ml/s. These were all statistically significant (p < 0.001). The mean weight of resected tissue was 74 g (43–206) with 25 patients having benign histopathology and two being diagnosed with prostate cancer (Gleason 3 + 3 = 6 and 3 + 4 = 7). No patients returned to theatre or required a blood transfusion.ConclusionsData from our patient cohort demonstrate the feasibility, safety and efficacy of RMFP for benign prostatic hyperplasia in an Australian patient cohort. Our outcomes compare favourably with published studies on RSP.

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A prospective comparative analysis of robot‐assisted vs open simple prostatectomy for benign prostatic hyperplasia

Abstract: The results showed that RASP provided similar functional outcomes to those of OSP, whilst maintaining a good (or even better) safety profile. Our results suggest that RASP is a viable, efficient and potentially superior alternative to the open procedure.

Cited by 41 publications

References 26 publications

Robot-assisted simple prostatectomy versus open simple prostatectomy: a single-center comparison

Robot-assisted simple prostatectomy versus open simple prostatectomy: a single-center comparison

Robotic-Assisted Simple Prostatectomy: A Systematic Review

Outcomes of robotic modified Freyer's prostatectomy in an Australian patient cohort

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