Robot-Assisted Laparoscopic Radical Prostatectomy: Perioperative Outcomes of 1500 Cases

Patel, Vipul; Palmer, Kenneth J.; Coughlin, Geoff; Samavedi, Srinivas

doi:10.1089/end.2008.9711

Cited by 195 publications

(134 citation statements)

References 17 publications

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“…The pathologic stage and PSM rates for open, RLP, and RARP series are summarized on Table 4, 16-22,24-28,30,31,33,55-57 Table 5, 33,37,38,[40][41][42][44][45][46][47] and Table 6, 30,31,35,[48][49][50][51][52][53][54]58 respectively. The pathologic stage in the RARP series was of 78.2% pT 2 tumors and 20.5% pT 3 tumors.…”

Section: Oncologic Outcomesmentioning

confidence: 99%

Retropubic, Laparoscopic, and Robot-Assisted Radical Prostatectomy: A Critical Review of Outcomes Reported by High-Volume Centers

Coelho

Rocco

Patel

et al. 2010

Journal of Endourology

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246

149

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Purpose: To critically review perioperative outcomes, positive surgical margin (PSM) rates, and functional outcomes of several large series of retropubic radical prostatectomy (RRP), laparoscopic RP (LRP), and robotassisted radical prostatectomy (RARP) currently available in the literature. Methods: A Medline database search was performed from November 1994 to May 2009, using medical subject heading search terms ''prostatectomy'' and ''Outcome Assessment (Health Care)'' and text words ''retropubic,'' ''robotic,'' and ''laparoscopic.'' Only studies with a sample size of 250 or more patients were considered. Weighted means were calculated for all outcomes using the number of patients included in each study as the weighing factor. Results: We identified 30 articles for RRP, 14 for LRP, and 14 for RARP. The mean intraoperative and postoperative RRP transfusion rates for RRP, LRP, and RARP were 20.1%, 3.5%, and 1.4%, respectively. The weighted mean postoperative complication rates for RRP, LRP, and RARP were 10.3% (4.8% to 26.9%), 10.98% (8.9 to 27.7%), and 10.3% (4.3% to 15.7%), respectively. RARP revealed a mean overall PSM rate of 13.6%, whereas LRP and RRP yielded a PSM of 21.3% and 24%, respectively. The weighted mean continence rates at 12 month follow-up for RRP, LRP, and RARP were 79%, 84.8%, and 92%, respectively. The weighted mean potency rates for patients who underwent unilateral or bilateral nerve sparing, at 12 month follow-up, were 43.1% and 60.6% for RRP, 31.1% and 54% for LRP, and 59.9% and 93.5% for RARP. Conclusion: RRP, LRP, and RARP performed in high-volume centers are safe options for treatment of patients with localized prostate cancer, presenting similar overall complication rates. LRP and RARP, however, are associated with decreased operative blood loss and decreased risk of transfusion when compared with RRP. Our analysis including high-volume centers also showed lower weighted mean PSM rates and higher continence and potency rates after RARP compared with RRP and LRP. However, the lack of randomized trials precludes definitive conclusions.

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Section: Oncologic Outcomesmentioning

confidence: 99%

Retropubic, Laparoscopic, and Robot-Assisted Radical Prostatectomy: A Critical Review of Outcomes Reported by High-Volume Centers

Coelho

Rocco

Patel

et al. 2010

Journal of Endourology

Self Cite

246

149

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“…In radical prostatectomy, the technique of robotic assistance, combining the increased abdominal pressure with a more intuitive handling of surgical instruments, shows a trend towards lower blood loss during surgery [33]. The average blood loss in patients without antiplatelet therapy using robotic assistance is 100-200 ml [34] compared to 800 ml for conventional radical prostatectomy [35]. Whether this holds true for patients under antiplatelet therapy remains to be studied.…”

Section: Hemorrhagic Risks In Urologic Surgerymentioning

confidence: 99%

Urological Surgery and Antiplatelet Drugs After Cardiac and Cerebrovascular Accidents

Eberli

Chassot²,

Sulser

et al. 2010

Journal of Urology

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Context: The perioperative management of patients under dual antiplatelet therapy after myocardial infarction, cerebrovascular event or coronary stent implantation represents an increasingly frequent issue for urologists and anaesthesiologists.Objective: To assess the current scientific evidence and propose strategies concerning the management of urologic patients under antiplatelet therapy. A Medline & PubMed search was conducted for articles related to antiplatelet therapy after myocardial infarction, coronary stents and cerebrovascular events, and to the management of aspirin and/or clopidogrel in the context of surgery.Results: Early discontinuation of antiplatelet therapy in secondary prevention is associated with a high risk of coronary thrombosis, further increased by the hypercoagulable state induced by surgery. Aspirin has recently been recommended to be a lifelong therapy. Clopidogrel is mandatory for 6 weeks after myocardial infarction and bare-metal stents, and for 12 months after drug-eluting stents. Surgery must be postponed beyond these waiting periods, or be performed under dual antiplatelet therapy, because withdrawal therapy increases 5-10 times the risk of postoperative myocardial infarction, stent thrombosis or death. The shorter the waiting periods between revascularisation and surgery, the higher is the risk of adverse cardiac events. The risk of surgical haemorrhage is increased approximately 20% by aspirin and 50% by clopidogrel. Conclusions:The present review of the literature demonstrates that the risk of coronary thrombosis when antiplatelet agents are withdrawn before surgery is generally higher than the risk of surgical haemorrhage when antiplatelet agents are upheld. However, this issue has not yet been sufficiently evaluated in urologic patients and in many instances during urologic surgery the risk of bleeding might be exceedingly dangerous. In this problematic situation, a thorough dialogue between surgeon, cardiologist and anaesthesiologist is essential to determine all risk factors and to define the best possible strategy for each individual patient.

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“…Two patients developed postoperative lymphocele; no description, however, was given of PLND selection criteria, boundaries, number of patients who underwent PLND, or nodal yield. 52 Link et al 53 reported on 1847 consecutive patients who underwent RALP; 1027 (55.6%) of whom also underwent concurrent PLND, with 15 (1.5%) demonstrating LNI; patient selection criteria, anatomic extent of dissection, and nodal yield were not reported.…”

Section: Large Seriesmentioning

confidence: 99%

Lymph node dissection during robot-assisted radical prostatectomy: where do we stand?

Silberstein

Derweesh

Kane

2009

Prostate Cancer Prostatic Dis

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Since the initial report of robot-assisted laparoscopic prostatectomy (RALP) in 2001, the technique has gained rapid acceptance and utilization. When compared with more traditional forms of surgical intervention, there is still much debate with respect to cost, and impact on potency and continence. Less often is the focus on oncologic outcomes. Pelvic lymph node dissection (PLND) at the time of prostatectomy is an important part of the surgical intervention for prostate cancer and is currently underreported during robotic procedures. Herein, we review the current controversies on the value and extent of PLND and the status of emerging data regarding robot-assisted PLND. IntroductionRadical prostatectomy has undergone an evolution in technique over many decades with older procedures being largely replaced by newer ones due to perceived superiority of oncologic outcomes or diminution of operative morbidity. [1][2][3] In the United States, da Vinci robot-assisted laparoscopic prostatectomy (RALP) has gained rapid popularity because of the facility with which it allows laparoscopic skills to be transferred to even non-laparoscopically trained surgeons. 4 Thus, the benefits of laparoscopy, enhanced optical magnification, decreased blood loss, and minimal incisions can be obtained without prolonged learning curves. Any time a new technique is introduced, it must be compared with current methods to ascertain at least equivalent outcomes, in addition to assessment of benefits, and limitations. To this end, there have been recent publications from the centers of excellence attempting to compare RALP to radical retropubic and pure laparoscopic techniques. 5,6 However, there has been a paucity of literature addressing pelvic lymph node dissection (PLND) at the time of RALP. This is not the case with all urologic robot-assisted procedures; recent literature on robot-assisted radical cystectomy has specifically focused on feasibility and adequacy of robot-assisted PLND. 7 Thus, the lack of literature on robot-assisted PLND at RALP may reflect that PLND at the time of prostatectomy performed through open technique (or otherwise) is a controversial topic. Important questions remain regarding patient selection, potential benefit and anatomic extent of the dissection, nodal yield, and complication rates. We will review these controversies and the state of the literature regarding RALP PLND in this context. Ongoing controversies in PLNDIn the United States, prostate cancer is the most commonly diagnosed noncutaneous cancer and the second-leading cause of cancer death among men. In 2008, 186 320 men were diagnosed with, and 28 660 men died of, prostate cancer in the United States. 8 The advent of prostate-specific antigen (PSA) screening has led to a profound stage migration such that men diagnosed in the PSA era are younger and have lower clinical and pathologic stage and lower mortality rates, and when treated they have improved margin-free status and biochemical progression-free survival and decreased extracapsular extension a...

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Robot-Assisted Laparoscopic Radical Prostatectomy: Perioperative Outcomes of 1500 Cases

Abstract: Our initial series represents one of the largest published series for perioperative outcomes of robotic assisted prostatectomy. Our data demonstrates the feasibility, safety and efficacy of the procedure.

Cited by 195 publications

References 17 publications

Retropubic, Laparoscopic, and Robot-Assisted Radical Prostatectomy: A Critical Review of Outcomes Reported by High-Volume Centers

Retropubic, Laparoscopic, and Robot-Assisted Radical Prostatectomy: A Critical Review of Outcomes Reported by High-Volume Centers

Urological Surgery and Antiplatelet Drugs After Cardiac and Cerebrovascular Accidents

Lymph node dissection during robot-assisted radical prostatectomy: where do we stand?

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