Robot-Assisted Laparoscopic Prostatectomy: The First 100 Patients—Improving Patient Safety and Outcomes

Tsao, Alice K.; Smaldone, Marc; Averch, Timothy D.; Jackman, Stephen V.

doi:10.1089/end.2008.0241

Cited by 17 publications

(11 citation statements)

References 9 publications

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“…Especially for the urologists and institutions starting this surgery, the initial experience including the assessment and prevention of adverse events will need to be studied [20]. Our data showing a lower ratio of POI including WBC and CRP compared to ORP can be explained by the following reasons: (1) The total length of fascia opened and closed in the surgical procedure is shorter in RALP (2.5 cm in diameter) than ORP (7-8 cm) even though the total length (amount) of incision is almost the same.…”

Section: Discussionmentioning

confidence: 99%

Comparison of Postoperative Infection between Robotic-Assisted Laparoscopic Prostatectomy and Open Radical Prostatectomy

et al. 2013

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Background: Robotic-assisted laparoscopic prostatectomy (RALP) has been rapidly adapted worldwide. The purpose of this study was to investigate postoperative infection (POI) after RALP and compare it with that after open radical prostatectomy (ORP). Methods: 89 consecutive RALP cases and 105 recent ORP cases were enrolled. POIs were categorized according to CDC guideline criteria. Laboratory data relating to infection such as serum white blood cells (WBC) and C-reactive protein (CRP) were comparatively investigated before and after the surgeries. Data were collected and analyzed retrospectively. Results: There was one surgical site infection patient in the RALP cases (1/89, 1.12%). ORP cases had a comparatively higher ratio of POI (6/105, 4.77%), but the difference did not reach statistical significance (p = 0.0876). The postoperative rise of serum WBC (postoperative days 1 and 4) and CRP (postoperative days 1, 4 and 7) was significantly suppressed from pre-surgery data in RALP when compared to ORP. Conclusions: RALP tended to have a lower rate of POI than ORP even though this change was not statistically significant and the postoperative rise of serum WBC and CRP was significantly suppressed in RALP compared to ORP. A prospective study with a standardized prophylactic antibiotic administration may be necessary for further evaluation of potential guidelines for RALP.

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Section: Discussionmentioning

confidence: 99%

Comparison of Postoperative Infection between Robotic-Assisted Laparoscopic Prostatectomy and Open Radical Prostatectomy

et al. 2013

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“…The use of robotic-assisted laparoscopic radical prostatectomy has been purposed in order to obtain better results in terms of quality of life and oncological outcomes (16 (18). Clearly, it is well known that RARP has greater incidence of neurovascular bundle preservation and faster convalescence than RRP, but it is also well known, that the success of the nerve-sparing technique is determined by the accurate selection of patients (19)(20). As suggested by Novara et al (21), in the era of robotic surgery, the key point for the success of the nerve-sparing technique is the accurate selection of patients.…”

Section: Discussionmentioning

confidence: 99%

Bilateral nerve sparing robotic-assisted radical prostatectomy is associated with faster continence recovery but not with erectile function recovery compared with retropubic open prostatectomy: The need for accurate selection of patients

et al. 2013

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Abstract. Robotic-assisted radical prostatectomy (RARP) shows measurable advantages, compared to conventional open surgery, even if some aspects are, still, under debate. The aim of this study was to compare the potency recovery rate of patients with clinically localised prostate cancer treated by bilateral nerve-sparing (BNS) RARP or retropubic radical prostatectomy (RRP), and secondarily, the urinary continence recovery evaluation and the oncological efficacy. All patients treated with BNS-RARP or BNS-RRP for clinically localised prostate cancer, performed by a single dedicated surgeon, between January 2004 and December 2008, were enrolled in this non-randomised prospective comparative study. The International Index of Erectile Function (IIEF) and erection hardness score (EHS), in the form of a questionnaire, were self-administered to each patient pre-operatively and after 12 months. The presence of surgical margins was considered as oncological outcome measure. Eighty-two patients underwent BNS-RARP while 48 underwent BNS-RRP. For BNS-RARP and BNS-RRP the median operative time was 221 and 103 min, respectively (P<0.001; df=128; t=721.43),and intra-operative blood loss was 280 and 565 ml, respectively (P<0.001; df=128; t=1742.44). At a mean follow-up period of 12.4±2.3 months, 12 patients (25%) in the BNS-RRP group and 22 (26.8%) in the BNS-RARP group were considered potent with or without drugs (P=0.81). Moreover, we did not find any statistically significant difference between the 2 groups in terms of IEFF and EHS scores after treatment (17.21 vs. 16.98; P=0.16 and 2.1 vs. 2.0; P=0.54). On the other hand, statistically significant differences between the 2 groups were found in terms of faster urinary continence recovery and the presence of positive surgical margins (P<0.001, P=0.009). Shorter catheterization duration (7 vs. 3 days) and post-operative hospital stays (8 vs. 4 days; P<0.001) were found in the BNS-RARP group compared to the BNS-RRP group. In conclusion, our results demonstrate that BNS-RARP does not improve erectile function recovery compared to open radical prostatectomy; however, it significantly improves urinary continence and decreases the presence of positive surgical margins.

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“…PSM rates in studies not comparing approaches ranged from 13% [25] to 42% [31] with a median 23% [27]. In the presence of a PSM, the failure rate was either double [28, 30, 32, 34, 40, 42, 43], triple [5, 26, 29, 38] or showed an increase of greater magnitude [4, 39] compared to NSM.…”

Section: Resultsmentioning

confidence: 99%

Frequency of Positive Surgical Margin at Prostatectomy and Its Effect on Patient Outcome

Iczkowski

Lucia

2011

Prostate Cancer

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A positive surgical margin at prostatectomy is defined as tumor cells touching the inked edge of the specimen. This finding is reported in 8.8% to 42% of cases (median about 20%) in various studies. It is one of the main determinants of eventual biochemical (PSA) failure, generally associated with a doubled or tripled risk of failure. The effect of a positive margin on outcome can be modified by stage or grade and the length, number and location of positive margins, as well as by technical operative approach and duration of operator experience. This paper tabulates data from the past decade of studies on margin status.

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Robot-Assisted Laparoscopic Prostatectomy: The First 100 Patients—Improving Patient Safety and Outcomes

Cited by 17 publications

References 9 publications

Comparison of Postoperative Infection between Robotic-Assisted Laparoscopic Prostatectomy and Open Radical Prostatectomy

Comparison of Postoperative Infection between Robotic-Assisted Laparoscopic Prostatectomy and Open Radical Prostatectomy

Bilateral nerve sparing robotic-assisted radical prostatectomy is associated with faster continence recovery but not with erectile function recovery compared with retropubic open prostatectomy: The need for accurate selection of patients

Frequency of Positive Surgical Margin at Prostatectomy and Its Effect on Patient Outcome

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