Functional outcomes and oncological efficacy of Vattikuti Institute prostatectomy with Veil of Aphrodite nerve‐sparing: an analysis of 154 consecutive patients

Kaul, Sanjeev; Savera, Adnan T.; Badani, Ketan K.; Fumo, Michael; Bhandari, Akshay; Menon, Mani

doi:10.1111/j.1464-410x.2006.05990.x

Cited by 172 publications

(107 citation statements)

References 30 publications

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“…For example, of the 2861 RRPs performed in Quebec between 1988 and 1993, on average 80% were by urologists using this surgery 12 times or less annually. 30 Our results compare favourably with RARP centres of excellence (Table 8), 20,27,[31][32][33][34][35][36][37][38][39][40][41] despite initial difficulties and operating mainly on patients with intermediate-to high-risk disease. …”

Section: First Robotic Prostatectomy Program In Quebecsupporting

confidence: 62%

Perioperative, oncological, and functional outcomes of the first robotic prostatectomy program in Quebec: Single fellowship-trained surgeon's experience of 250 cases

Alhathal

El-Hakim

2013

CUAJ

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Background: Robotic-assisted radical prostatectomy (RARP) is being increasingly done in Canada. Despite this, the Canadian literature lacks publications on the oncologic and functional outcomes of RARP. The objective of this study is to report the longest single surgeon experience in the province of Quebec. Methods: We collected prospective data from 250 consecutive patients who underwent RARP by a single fellowship trained surgeon (AEH) from October 2006 to October 2012. Mean followup was 28 months (range: 1-72). The D'Amico risk stratification distribution was 34% in low-risk, 48% in intermediate-risk and 18% in high-risk groups. Results: The mean operation time (±SD) was 194 ± 60.6 minutes, and estimated blood loss 318 ± 179 mL. The transfusion rate was only 0.4%. All procedures were completed robotically. The mean hospital stay was 1.2 days, and 88% of patients were discharged on postoperative day 1. The mean catheterization time was 7 days (range: 6-13). There were 2% major (Clavien III-IV) and 7.2% minor (Clavien I-II) postoperative complications, and no mortalities. On final pathology, 76% of patients were organ-confined and 70% specimen-confined. Pathological Gleason sum ≥7 accounted for 86%. Return of urinary continence (0-pads) at 3, 6, 12, and 24 months was 73.3%, 83.5%, 92.3%, 96.5%, respectively. Potency rate (successful penetration with or without medication) at 6, 12, and 24 months was 49.3%, 85%, and 95.3%, respectively. Operative time and positive surgical margin (PSM) in organ-confined disease (pT2) decreased significantly after 50 cases. Seventeen patients (6.8%) had no undetectable prostate-specific antigen (PSA) at first visit (PSA <0.1 ng/mL). Of remaining 233 patients, biochemical recurrence (PSA >0.2 ng/mL) was 4.7% (11 patients), and another 3.4% (8 patients) received early salvage radiotherapy (rising PSA, but <0.2 ng/mL). No patients with undetectable PSA required salvage treatments within 6 months postoperatively. Conclusions:Our results compare favourably with high-volume RARP programs, despite mainly intermediate-to high-risk disease. Initial learning curve was estimated to be 50 cases. Fellowship training was instrumental in achieving adequate functional and oncological outcomes, while maintaining low complications rate.

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Section: First Robotic Prostatectomy Program In Quebecsupporting

confidence: 62%

Perioperative, oncological, and functional outcomes of the first robotic prostatectomy program in Quebec: Single fellowship-trained surgeon's experience of 250 cases

Alhathal

El-Hakim

2013

CUAJ

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“…Since first described in 2001, robotic-assisted radical prostatectomy (RARP) has continued to gain widespread acceptance with less postoperative morbidity, reduced blood loss, along with some supportive data of improved early continence and erectile function recovery. [1][2][3] For these reasons, over 80% of radical prostatectomies are performed robotically in the United States, 4 as well as growing percentages globally. Moreover, acquisition of robotic skills is crucial in the early learning curve particularly for residents, fellows, and urologists already established in practice.…”

Section: Introductionmentioning

confidence: 99%

Factors predicting prolonged operative time for individual surgical steps of robot-assisted radical prostatectomy (RARP): A single surgeon’s experience

Al‐Enizi

Valdivieso

Meskawi

et al. 2015

CUAJ

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Introduction: We evaluated the average time required to complete individual steps of robotic-assisted radical prostatectomy (RARP) by an expert RARP surgeon. The intent is to help establish a timebased benchmark to aim for during apprenticeship. In addition, we aimed to evaluate preoperative patient factors, which could prolong the operative time of these individual steps. Methods: We retrospectively identified 247 patients who underwent RARP, performed by an experienced robotic surgeon at our institution. Baseline patient characteristics and the duration of each step were recorded. Multivariate analysis was performed to predict factors of prolonged individual steps. Results: In multivariable analysis, obesity was a significant predictor of prolonged operative time of: docking (odds ratio [OR] 1.96), urethral division (OR 3.13), and vesico-urethral anastomosis (VUA) (OR 2.63). Prostate volume was also a significant predictor of longer operative time in dorsal vein complex ligation (OR 1.02), bladder neck division (OR 1.03), pedicle control (OR 1.04), urethral division (OR 1.02), and VUA (OR 1.03). A prolonged bladder neck division was predicted by the presence of a median lobe (OR 5.03). Only obesity (OR 2.56) and prostate volume (OR 1.04) were predictors of a longer overall operative time. Conclusions: Obesity and prostate volume are powerful predictors of longer overall operative time. Furthermore, both can predict prolonged time of several individual RARP steps. The presence of a median lobe is a strong predictor of a longer bladder neck division. These factors should be taken into consideration during RARP training. IntroductionThe introduction of the da Vinci robotic system (Intuitive Surgical, Inc.) has made a dramatic impact in the treatment of localized prostate cancer. Since first described in 2001, robotic-assisted radical prostatectomy (RARP) has continued to gain widespread acceptance with less postoperative morbidity, reduced blood loss, along with some supportive data of improved early continence and erectile function recovery.1-3 For these reasons, over 80% of radical prostatectomies are performed robotically in the United States, 4 as well as growing percentages globally. Moreover, acquisition of robotic skills is crucial in the early learning curve particularly for residents, fellows, and urologists already established in practice. However, lack of a standardized robotic training curriculum, coupled with reduced resident working hours, impose further difficulties in the mastering of robotic techniques during training.The learning curve of RARP is complex as well as its definition. When using a 4-hour case proficiency, Ahlering and colleagues reported a RARP learning curve of 12 cases for a laparoscopic-naïve surgeon.5 In a recent report by Al-Hathal and colleagues, the RARP learning curve of a fellowshiptrained surgeon was evaluated at 50 cases after which the positive surgical margin (PSM) rate in organ-confined disease was significantly reduced and the overall operative time (OT) was ...

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“…When men using PDE-5 inhibitors were included, 17 of 23 (74%) men in the standard technique group and 34 of 35 (97%) in the Veil of Aphrodite group achieved erections strong enough for sexual intercourse. However, a further report of 154 men from the same institute undergoing RALRP using the Veil technique described a rate of recovery of normal erections (SHIM > 21) at 12 months of only 71% [32]. When men using PDE-5 inhibitors were excluded, the number dropped to 26%.…”

Section: Potency Outcomementioning

confidence: 99%

Outcomes after robot-assisted laparoscopic radical prostatectomy

Murphy¹,

Challacombe²,

Costello³

2008

Asian J Androl

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Functional outcomes and oncological efficacy of Vattikuti Institute prostatectomy with Veil of Aphrodite nerve‐sparing: an analysis of 154 consecutive patients

Cited by 172 publications

References 30 publications

Perioperative, oncological, and functional outcomes of the first robotic prostatectomy program in Quebec: Single fellowship-trained surgeon's experience of 250 cases

Perioperative, oncological, and functional outcomes of the first robotic prostatectomy program in Quebec: Single fellowship-trained surgeon's experience of 250 cases

Factors predicting prolonged operative time for individual surgical steps of robot-assisted radical prostatectomy (RARP): A single surgeon’s experience

Outcomes after robot-assisted laparoscopic radical prostatectomy

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