Robot‐assisted extraperitoneal laparoscopic radical prostatectomy: experience in a high‐volume laparoscopy reference centre

Abstract

surgeon were distributed into five groups according to the chronological order of the procedures. The mean follow-up after RALP was 18.3 months. Patient demographics, surgical data and postoperative variables were collected into a prospective database. Data were compared by chronological groups into single-surgeon cohort. RESULTSThe median operative time and blood loss were 140 min and 350 mL, respectively. The complication rate was 8.3%. Cancers were pT3-4 in 34.5%. The mean hospital stay and duration of bladder catheterization were 4.3 and 8.2 days, respectively. The rate of positive surgical margins (PSMs) was 17.2% in pT2 cancers. The recovery rate of continence was 98% at 12 months. Intraoperative time, blood loss and length of hospital stay were significantly improved after a short learning curve. The continence recovery, the rate and the length of PSM were also improved beyond the learning curve, but difference was not statistically significant. CONCLUSIONSRALP is a safe and reproducible procedure and offers a short learning curve for experienced laparoscopic surgeons. Beyond the learning curve, continued experience might also provide further improvements in terms of operative, pathological and functional results. KEYWORDSprostate cancer, radical prostatectomy, robotic assistance, learning curve Study Type -Therapy (case series) Level of Evidence 4 OBJECTIVETo describe our current procedure of robotassisted laparoscopic radical prostatectomy (RALP), and to assess the effect of the learning curve on perioperative data, early oncological outcomes and functional results, as RALP has increasingly become a treatment option for men with localized prostate cancer.

Evaluating the Learning Curve of Experienced Laparoscopic Surgeons in Robot-Assisted Radical Prostatectomy

“…While the perioperative complication rate and outcomes at 3 months from the LRP group were satisfactory (not unexpected, given our significant previous experience), we have also achieved similar outcomes from our initial RALP group. Also, our preliminary RALP outcomes are at par with previous series published by groups significantly more established in the technique 24,25 and better than other groups that commenced RALP without such a large previous experience of LRP; earlier series published by Rozet and colleagues 24 and Ploussard and coworkers, 26 evaluating RALP outcomes after the initial 133 and 206 patients, respectively, have reported mean blood loss of 609 and 504 mL, respectively, and a complication rate of 19.4% and 16.5%, respectively. This is significantly higher than this current series.…”

Extraperitoneal robot-assisted laparoscopic radical prostatectomy: Initial experience

“…Our operative time of 128 min is comparable to the other reported series performing extraperitoneal RALP. [151617] In our series, we did not find any abdominal complications like ileus and obstruction, and the overall morbidity was low and similar to that reported in the literature. [18] The mean blood loss in our series was 210 mL.…”

“…The extraperitoneal approach has also been described with equivalent efficacy to the transperitoneal approach. [71314151617] After performing more than 200 transperitoneal RALPs, we switched over to extraperitoneal RALP using a five-port technique. Our operative time of 128 min is comparable to the other reported series performing extraperitoneal RALP.…”

Characteristics of positive surgical margins in robotic-assisted radical prostatectomy, open retropubic radical prostatectomy, and laparoscopic radical prostatectomy: a comparative histopathologic study from a single academic center

“…RRP, LRP, and RARP are currently the 3 most commonly used surgical modalities for treating clinically organconfined PCa [10,16,[20][21][22][23][24]. Only a few studies have compared the incidence of PSM in the 3 surgical techniques.…”