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International Journal of Clinical... Nov 2021To evaluate the safety (perioperative adverse events) of robot-assisted radical prostatectomy (RARP) and functional outcomes (continence and erectile dysfunction) of...
AIM
To evaluate the safety (perioperative adverse events) of robot-assisted radical prostatectomy (RARP) and functional outcomes (continence and erectile dysfunction) of open and robotic radical prostatectomy in elderly patients.
METHODS
The data of patients (≥70 years old) who underwent open retropubic radical prostatectomy (ORRP) and RARP within the period from November 2014 to February 2019 were evaluated retrospectively. The perioperative adverse events and the functional outcomes of both surgical approaches were evaluated.
RESULTS
A total of 149 men (59.3%) underwent ORRP, and 102 men (41.7%) underwent RARP. The mean age in the ORRP group was 73.6 ± 3.2 years, and that in the RARP group was 74.7 ± 4.1 years. The rate of grade 3 or higher (major) complications for the ORRP group was 4.7% (7 out of 149), and that for the RARP group was 4.9% (5 out of 102). The 24 months full continence and potency rates of the ORRP and RARP groups were 78.5% vs 79.4% and 21.8% vs 22.6%, respectively.
CONCLUSION
The perioperative adverse events are similar in elderly patients undergoing ORRP and in RARP. The continence rates are favourable and reasonable, although the potency rates are low in elderly men who underwent prostatectomy. The results of the present study may be useful for surgeons in their decision making and counselling of elderly patients.
Topics: Aged; Humans; Male; Prostatectomy; Prostatic Neoplasms; Retrospective Studies; Robotics; Treatment Outcome
PubMed: 34431181
DOI: 10.1111/ijcp.14754 -
The Journal of Urology Feb 2016Robotic assisted radical prostatectomy has largely replaced open radical prostatectomy for the surgical management of prostate cancer despite conflicting evidence of... (Comparative Study)
Comparative Study
PURPOSE
Robotic assisted radical prostatectomy has largely replaced open radical prostatectomy for the surgical management of prostate cancer despite conflicting evidence of superiority with respect to disease control or functional sequelae. Using population cohort data, in this study we examined sexual and urinary function in men undergoing open radical prostatectomy vs those undergoing robotic assisted radical prostatectomy.
MATERIALS AND METHODS
Subjects surgically treated for prostate cancer were selected from 2 large population based prospective cohort studies, the Prostate Cancer Outcomes Study (enrolled 1994 to 1995) and the Comparative Effectiveness Analysis of Surgery and Radiation (enrolled 2011 to 2012). Subjects completed baseline, 6-month and 12-month standardized patient reported outcome measures. Main outcomes were between-group differences in functional outcome scores at 6 and 12 months using linear regression, and adjusting for baseline function, sociodemographic and clinical characteristics. Sensitivity analyses were used to evaluate outcomes between patients undergoing open radical prostatectomy and robotic assisted radical prostatectomy within and across CEASAR and PCOS.
RESULTS
The combined cohort consisted of 2,438 men, 1,505 of whom underwent open radical prostatectomy and 933 of whom underwent robotic assisted radical prostatectomy. Men treated with robotic assisted radical prostatectomy reported better urinary function at 6 months (mean difference 3.77 points, 95% CI 1.09-6.44) but not at 12 months (1.19, -1.32-3.71). Subjects treated with robotic assisted radical prostatectomy also reported superior sexual function at 6 months (8.31, 6.02-10.56) and at 12 months (7.64, 5.25-10.03). Sensitivity analyses largely supported the sexual function findings with inconsistent support for urinary function results.
CONCLUSIONS
This population based study reveals that men undergoing robotic assisted radical prostatectomy likely experience less decline in early urinary continence and sexual function than those undergoing open radical prostatectomy. The clinical meaning of these differences is uncertain and longer followup will be required to establish whether these benefits are durable.
Topics: Aged; Humans; Male; Middle Aged; Postoperative Complications; Prospective Studies; Prostatectomy; Prostatic Neoplasms; Robotic Surgical Procedures; SEER Program; Treatment Outcome; United States
PubMed: 26343985
DOI: 10.1016/j.juro.2015.08.092 -
World Journal of Urology Sep 2023To provide an update on the diverse, contemporary urological applications of the Hugo™ RAS system. (Review)
Review
PURPOSE
To provide an update on the diverse, contemporary urological applications of the Hugo™ RAS system.
METHODS
A comprehensive literature review was performed to identify studies that described the clinical applications of the Hugo™ RAS system in Urology. The Hugo™ RAS is a new multi-modular robotic platform created by Medtronic, which offered new innovations, including an open surgical console and individual modular and extendable robotic arms that come in their own movable platforms. Since obtaining regulatory approval in Europe in October 2021, the novel platform has been increasingly used in various urologic and gynecologic procedures.
RESULTS
A total of 10 studies were included, which involved 176 patients who underwent varying urological procedures. These included radical and simple prostatectomy, partial nephrectomy, radical and simple nephrectomy, ureterolithotomy, ureteral reimplant, pyeloplasty, and adrenalectomy. The different docking configurations, operating room set-ups, and early perioperative outcomes were described for the respective procedure.
CONCLUSION
Based on the existing literature, the Hugo™ RAS system can be safely and effectively utilized for various urological procedures. The novel technology provided additional value in enriching the repertoire of urological minimally invasive surgical options. Further research with larger cohort of patients will be required to better refine the operating techniques and understand the perioperative outcomes of the Hugo™ RAS, especially when compared to other robotic surgical platforms.
Topics: Male; Humans; Female; Urologic Surgical Procedures; Robotic Surgical Procedures; Robotics; Prostatectomy; Nephrectomy
PubMed: 37515649
DOI: 10.1007/s00345-023-04538-1 -
World Journal of Urology Feb 2024To describe the surgical techniques and to analyse the outcomes of single-port robot-assisted simple prostatectomy (SP RASP) procedure for the surgical treatment of... (Comparative Study)
Comparative Study Review
PURPOSE
To describe the surgical techniques and to analyse the outcomes of single-port robot-assisted simple prostatectomy (SP RASP) procedure for the surgical treatment of benign prostatic hyperplasia (BPH).
METHODS
Three databases (PubMed®, Web of Science™, and Scopus®) were queried to identify studies reporting on the technical aspects and outcomes of SP RASP. Different combinations of keywords were used, according to a free-text protocol, to identify retrospective and prospective studies, both comparative and non-comparative, systematic reviews (SR) and meta-analysis (MA) describing surgical techniques for SP RASP and the associated surgical and functional outcomes.
RESULTS
The transvesical approach represents the most common approach for SP RASP. A decrease in terms of estimated blood loss was observed when SP RASP was compared to open simple prostatectomy (OSP) and multi-port (MP) RASP. Furthermore, this technique allowed for a shorter length of hospital stay (LoS) and a lower post-operative complication rate, compared to OSP. Post-operative subjective and objective functional outcomes are satisfying and comparable to OSP and MP RASP.
CONCLUSION
SP RASP represents a safe and feasible approach for the surgical management of BPH. It provides comparable surgical and functional outcomes to MP RASP, enabling for minimal invasiveness, enhanced recovery, and potential for improving patient care.
Topics: Humans; Male; Prostatectomy; Prostatic Hyperplasia; Robotic Surgical Procedures; Robotics; Treatment Outcome; Databases, Factual
PubMed: 38393399
DOI: 10.1007/s00345-024-04778-9 -
Archivio Italiano Di Urologia,... Mar 2022Robotic-assisted simple prostatectomy (RASP) is a novel surgical procedure for the management of obstructive symptoms caused by enlarged prostate glands. Before the...
PURPOSE
Robotic-assisted simple prostatectomy (RASP) is a novel surgical procedure for the management of obstructive symptoms caused by enlarged prostate glands. Before the introduction of minimally invasive techniques, the standard approach was the open simple prostatectomy (OSP). The aim of our study was to compare intraoperative and perioperative outcomes of robotic (RASP) and laparoscopic (LSP) simple prostatectomy.
METHODS
We retrospectively analyzed data from patients who underwent minimally invasive simple prostatectomy at the Urological Department of Portogruaro Hospital, Portogruaro, and at the Urological Department of "San Bassiano" Hospital, in Bassano del Grappa, from March 2015 to December 2020. Data collected from medical records included age, body mass index, prostate volume, operative time, preoperative International Prostatic Symptoms Score (IPSS), postoperative IPSS, time with drainage, blood transfusion, intraoperative complications, perioperative complications and length of hospital stay.
RESULTS
Robotic-assisted (n = 25) and laparoscopic simple prostatectomy (n = 25) were performed with a transvesical approach. No significant differences were observed regarding baseline characteristics, body mass index, prostate volume and IPSS. Operative time was lower in the laparoscopic group (122 min vs 139 min) (p = 0.024), while hospital stay was lower in the robotic group (4 days vs 6 days) (p = 0.047).
CONCLUSIONS
Robotic-assisted simple prostatectomy is a safe technique with results comparable to laparoscopic simple prostatectomy, encompassing the advantage of a shorter hospitalization. Considering the costs and the limited availability of robotic-assisted simple prostatectomy, laparoscopic simple prostatectomy is a valid and safe alternative for experienced surgeons.
Topics: Humans; Laparoscopy; Male; Prostatectomy; Prostatic Hyperplasia; Retrospective Studies; Robotic Surgical Procedures
PubMed: 35352523
DOI: 10.4081/aiua.2022.1.37 -
Urologia May 2021Robotic assisted laparoscopic radical prostatectomy (RALRP) following endoscopic resection of the prostate is known to be feasible with good outcomes. However, the... (Review)
Review
INTRODUCTION
Robotic assisted laparoscopic radical prostatectomy (RALRP) following endoscopic resection of the prostate is known to be feasible with good outcomes. However, the literature evidence is limited on the feasibility and outcomes of RALRP following open prostatic surgery. In this study, our aim was to report our experience with RALRP in patients who had undergone trans-vesical adenomectomy of the prostate in the past.
PATIENTS AND METHODS
We reviewed our prospectively maintained database of men treated with RALRP at our institution to identify patients with previous history of open suprapubic trans-vesical adenomectomy, between 2016 and 2020. Data were collected on demographic information, interventions, oncological outcomes and follow-up.
RESULTS
Out of 362 patients, four individuals were identified that had previous open suprapubic trans-vesical adenomectomy. The mean age was 71 years with a mean pre-operative prostate specific antigen (PSA) of 11.35 ng/ml, and an average of 10 years after their trans-vesical adenomectomy. The mean console time was 119 min with an average estimated blood loss of 137.5 ml and 75% underwent lymphadenectomy. Post-operatively, all patients were discharged after 1 day with their urinary catheters removed at 7 days post-op. For one of the patients, a urine leak was identified, and his pelvic drain was removed at 5 days instead of 1 day as for the other three patients. No other complications were noted within 30 days. The average prostate weight was 54.7 g with all specimens being T3a R0. At 6 weeks follow-up, PSA was undetectable, three patients reported full continence and 1 was using two pads/day.
CONCLUSION
RALRP following previous open trans-vesical prostatectomy is feasible and safe with excellent oncological outcomes. They are, however, more challenging and cumbersome with increased console time.
Topics: Aged; Humans; Laparoscopy; Male; Prospective Studies; Prostatectomy; Prostatic Hyperplasia; Robotic Surgical Procedures; Urinary Bladder
PubMed: 33300455
DOI: 10.1177/0391560320979858 -
The Urologic Clinics of North America Feb 2021Laparoscopic prostatectomy was technically challenging and not widely adopted. Robotics led to the widespread adoption of minimally invasive prostatectomy, which has... (Review)
Review
Laparoscopic prostatectomy was technically challenging and not widely adopted. Robotics led to the widespread adoption of minimally invasive prostatectomy, which has been used heavily, supplanting the open and traditional laparoscopic approach. The benefits of robotic prostatectomy are disputed. Data suggest that robotic prostatectomy outcomes have improved over time.
Topics: History, 19th Century; History, 20th Century; History, 21st Century; Humans; Laparoscopy; Male; Prostatectomy; Prostatic Neoplasms; Quality Improvement; Robotic Surgical Procedures
PubMed: 33218592
DOI: 10.1016/j.ucl.2020.09.015 -
The Prostate Sep 2023To assess the impact of urinary continence and erectile function on the quality of life in men undergoing radical prostatectomy (RP) for prostate cancer (PC), we...
OBJECTIVES
To assess the impact of urinary continence and erectile function on the quality of life in men undergoing radical prostatectomy (RP) for prostate cancer (PC), we analyzed the preoperative and 1-year postoperative outcomes of five functional domains and their influencing factors.
PATIENTS AND METHODS
In this prospective study, all patients undergoing open or robot-assisted RP between Febuary 2017 and March 2020 in a single academic center were included. Patient-reported outcomes were assessed pre- and 12 months postoperatively using the Expanded Prostate Index Composite (EPIC-26) survey, evaluating continence, irritative/obstructive micturition, gastrointestinal symptoms, sexuality, and overall vitality. We examined the impact of RP on sexual function and urinary continence using multivariable logistic regression models, accounting for patient and tumor characteristics.
RESULTS
Overall, 1313 consecutive patients gave consent for study participation and completed both surveys. The median age was 66 years (IQR: 60-70). The majority of patients (n = 601, 46%) had an intermediate risk PC. Robotic RP was performed in 71.6% and nerve-sparing technique in 81% of the cases. The median pre- versus postoperative scores were the following: urinary continence 100 (IQR: 91.8-100) versus 85.5 (64.8-100), irritative micturition 87.5 (IQR: 75-100) versus 93.8 (IQR: 87.5-100), gastrointestinal symptoms the same with 100 (IQR: 95.8-100), vitality 95 (IQR: 80-100) versus 90 (IQR: 75-100), and erectile function 65.3 (IQR: 38.8-87.5) versus 22.2 (IQR: 12.5-48.7), respectively. Age (p < 0.001), risk classification (p = 0.002), and nerve-sparing surgery (p = 0.016) were associated with good sexual function (EPIC-26 score ≥60), while only age (p = 0.001) was statistically significantly associated with good urinary continence (EPIC-26 score ≥80).
CONCLUSION
Non-modifiable factors such as age and PC risk classification impact urinary continence and sexual function after RP. Nevertheless, urologic surgeons should further focus on improving nerve-sparing techniques, the only modifiable variable, to reduce the surgery's negative impact on urinary continence and sexual function.
Topics: Male; Humans; Aged; Prostate; Erectile Dysfunction; Quality of Life; Prospective Studies; Urinary Incontinence; Prostatectomy; Prostatic Neoplasms; Treatment Outcome
PubMed: 37350456
DOI: 10.1002/pros.24591 -
Japanese Journal of Clinical Oncology Dec 2019To assess patient-reported outcomes after open radical prostatectomy, laparoscopic radical prostatectomy and permanent prostate brachytherapy.
OBJECTIVE
To assess patient-reported outcomes after open radical prostatectomy, laparoscopic radical prostatectomy and permanent prostate brachytherapy.
METHODS
patient-reported outcomes were evaluated using Expanded Prostate Cancer Index Composite scores at baseline and 1, 3, 6, 12 and 36 months after treatment, respectively, using differences from baseline scores.
RESULTS
Urinary function was the same in the three groups at baseline, but worse after surgery than after permanent prostate brachytherapy until 12 months, and similar after open radical prostatectomy and permanent prostate brachytherapy and better than after laparoscopic radical prostatectomy at 36 months. Urinary bother was significantly worse at 1 month after surgery, but better after open radical prostatectomy than after permanent prostate brachytherapy and laparoscopic radical prostatectomy at 3 months, after which symptoms improved gradually in all groups. Obstructive/irritative symptoms were worse after permanent prostate brachytherapy than after open radical prostatectomy at 36 months, and worse after laparoscopic radical prostatectomy until 6 months. Urinary incontinence was worse after surgery, particularly after 1 month. This symptom returned to the baseline level at 12 months after open radical prostatectomy, but recovery after laparoscopic radical prostatectomy was slower. Bowel function after permanent prostate brachytherapy was significantly worse than after surgery at 1 month and this continued until 6 months. Bowel bother was slightly worse at 3 and 6 months after permanent prostate brachytherapy compared to these time points after surgery.
CONCLUSION
Urinary function and bother were worst after laparoscopic radical prostatectomy, especially in the early postoperative phase, whereas urinary obstructive/irritative symptom, bowel function and bother were worse after permanent prostate brachytherapy. These findings are useful and informative for the treatment of patients with prostate cancer.
Topics: Aged; Brachytherapy; Humans; Laparoscopy; Male; Middle Aged; Patient Reported Outcome Measures; Prospective Studies; Prostatectomy; Prostatic Neoplasms; Quality of Life; Urinary Incontinence
PubMed: 31436793
DOI: 10.1093/jjco/hyz116 -
Scandinavian Journal of Urology Aug 2016Objective Anastomotic complications are well known after radical prostatectomy (RP). The vesicourethral anastomotic technique is handled differently between open and...
Objective Anastomotic complications are well known after radical prostatectomy (RP). The vesicourethral anastomotic technique is handled differently between open and robotic RP. The aim of the study was to investigate whether the frequency of anastomotic leakages and strictures differed between patients undergoing retropubic radical prostatectomy (RRP) and robot-assisted radical prostatectomy (RARP) and to identify risk factors associated with these complications. Materials and methods The study included 735 consecutive patients who underwent RRP (n = 499) or RARP (236) at the Department of Urology, Rigshospitalet, Denmark, in a complete 3 year period from 2010 to 2012. Univariate and multivariate logistic regression analysis was used to analyse associations between surgical procedure (RRP vs RARP) and anastomotic complications. Analyses included age, smoking status, diabetes, hypertension, surgeon, prostate volume and anastomotic leakage as variables. Owing to a low number of events, multivariable analyses only included smoking status, diabetes and prostate volume for anastomotic leakage, and age, smoking status, prostate volume and anastomotic leakage for anastomotic strictures. Results The frequency of anastomotic leakage was 2.9%. Anastomotic stricture was seen in 4.9% of patients during follow-up. No differences were found in the frequency of anastomotic leakage (p = 0.35) or strictures (p = 0.35) between RRP and RARP. Univariate analysis demonstrated an association between surgeon and the risk of anastomotic strictures in RRP patients (p = 0.02). No other independent risk factors were identified. Conclusion Overall, the anastomotic complication rate in this cohort is similar to other published reports. No obvious risk factors for anastomotic complications could be identified, which in part was due to the low number of events.
Topics: Adult; Aged; Anastomosis, Surgical; Anastomotic Leak; Constriction, Pathologic; Humans; Laparoscopy; Male; Middle Aged; Postoperative Complications; Prostatectomy; Robotic Surgical Procedures; Urethra; Urinary Bladder
PubMed: 26963663
DOI: 10.3109/21681805.2016.1145735