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Expert Review of Anticancer Therapy Sep 2007The introduction of robotic laparoscopic assisted prostatectomy at our institution and nationwide has been a great advancement and has caused us to focus and fine-tune... (Review)
Review
The introduction of robotic laparoscopic assisted prostatectomy at our institution and nationwide has been a great advancement and has caused us to focus and fine-tune our goal for improvements in prostate cancer outcomes whether the patient elects for robotic laparoscopic assisted prostatectomy or open minimally invasive radical retropubic prostatectomy. While these authors favor the open technique performed by highly skilled urologic surgical oncologists, the lessons we have learned to date suggest that it is the skill of the surgeon that determines outcome, regardless of whether or not the operation is performed by an open or robotic laparoscopic technique. The concepts we have articulated here are related to resection and avoidance of positive margins, limited intraoperative blood loss and pain control, which allow equivalence in these outcome areas, regardless of technique.
Topics: Humans; Male; Minimally Invasive Surgical Procedures; Postoperative Complications; Prostatectomy; Prostatic Neoplasms
PubMed: 17892432
DOI: 10.1586/14737140.7.9.1309 -
British Journal of Urology Nov 1990
Review
Topics: Humans; Male; Postoperative Complications; Prostate; Prostatectomy; Reoperation; Risk Factors; Time Factors; Urethral Stricture
PubMed: 2249109
DOI: 10.1111/j.1464-410x.1990.tb14986.x -
Journal of the National Comprehensive... Aug 2007Robotic-assisted laparoscopic radical prostatectomy is now one of the most common ways to treat prostate cancer. Although it is undoubtedly an outstanding procedure, in... (Review)
Review
Robotic-assisted laparoscopic radical prostatectomy is now one of the most common ways to treat prostate cancer. Although it is undoubtedly an outstanding procedure, in many contexts the advantages of the laparoscopic approach are overstated. The authors believe that open radical prostatectomy will continue to have an important role. For example, an extensive lymphadenectomy is more easily accomplished with the open technique and may be important in staging and possibly curing patients at high risk for prostate cancer. Also, tactile sensation is a valuable asset in assessing the extent of local tumor, and this cannot yet be replicated with a robotic approach. Furthermore, obese patients, those with a history of extensive prior surgical procedures, and men with extremely large prostates may experience advantages with the open technique. Finally, the open approach has a significant advantage in terms of hospital costs.
Topics: Humans; Laparoscopy; Male; Prostatectomy; Prostatic Neoplasms
PubMed: 17692171
DOI: 10.6004/jnccn.2007.0058 -
Annals of the Royal College of Surgeons... Mar 2007
Review
Topics: Blood Loss, Surgical; Costs and Cost Analysis; Education, Medical, Continuing; Erectile Dysfunction; Humans; Laparoscopy; Length of Stay; Male; Postoperative Complications; Prostatectomy; Prostatic Neoplasms; Urinary Incontinence
PubMed: 17346400
DOI: 10.1308/003588407X168343 -
The Urologic Clinics of North America May 1995In properly selected patients, TURP has the highest probability of symptom relief of any strategy of BPH management except open prostatectomy, the outcomes of which are... (Review)
Review
In properly selected patients, TURP has the highest probability of symptom relief of any strategy of BPH management except open prostatectomy, the outcomes of which are but marginally better. However, open prostatectomy suffers from lack of patient acceptance, increased postoperative discomfort, and prolonged hospitalization, factors which over the past six decades relegated it to a minor role in the surgical management of BPH. Given the advanced age and compromised health status of most men undergoing TURP, the procedure's current mortality, morbidity, and long-term complication rates are remarkable. The ultimate role of the emerging alternative strategies of BPH management--hormonal, pharmacologic, thermal, and device discussed elsewhere in this issue, will be dependent upon their durability and their long-term outcomes, which remain to be fully defined. In the meantime, TURP remains the standard against which all new therapies must be measured. The resectoscope is being challenged but is not yet ready for the history books.
Topics: Humans; Intraoperative Complications; Male; Postoperative Complications; Prostatectomy
PubMed: 7762111
DOI: No ID Found -
International Braz J Urol : Official... 2008To review the current status of laparoscopic radical prostatectomy (LRP) and robotic assisted radical prostatectomy (RALP) in relation to radical retropubic... (Comparative Study)
Comparative Study Review
INTRODUCTION
To review the current status of laparoscopic radical prostatectomy (LRP) and robotic assisted radical prostatectomy (RALP) in relation to radical retropubic prostatectomy (RRP) in the management of localized prostate cancer.
MATERIALS AND METHODS
Between 1982 and 2007 published literature was reviewed using the National Library of Medicine database and the following key words: retropubic, laparoscopic, robotic, robot-assisted, and radical prostatectomy. Special emphasis was given to the technical and cost considerations as well as operative, functional and oncologic outcomes. In particular, reports with pioneering work that have contributed to the evolution of the technique, presenting comparative outcomes and with large series encompassing intermediate/long term follow-up, were taken into account.
RESULTS
After intermediate term follow-up, LRP and RALP achieved similar oncologic and functional results compared to RRP. However, LRP and RALP were associated with decreased blood loss, faster convalescence and better cosmetics when compared to RRP. The RALP technique is undoubtedly more expensive.
CONCLUSIONS
The oncologic and functional outcomes for LRP and RALP are similar to RRP after intermediate term follow-up. Long term follow-up and adequately designed studies will determine the inherent advantages and disadvantages of the individual techniques in the management of localized prostate cancer.
Topics: Follow-Up Studies; Humans; Laparoscopy; Male; Postoperative Complications; Prostatectomy; Prostatic Neoplasms; Robotics; Surgery, Computer-Assisted; Treatment Outcome
PubMed: 18601755
DOI: 10.1590/s1677-55382008000300002 -
Current Urology Reports May 2006Radical prostatectomy has maintained paramount importance in prostate cancer management. Emerging alternative treatments are laparoscopic and robotic prostatectomy.... (Comparative Study)
Comparative Study Review
Radical prostatectomy has maintained paramount importance in prostate cancer management. Emerging alternative treatments are laparoscopic and robotic prostatectomy. Technical modifications have improved radical prostatectomy outcomes, yet surgery remains difficult to perform regardless of approach. Contemporary series have shown comparable outcomes with operative time, transfusion rates, analgesia, and length of catheterization. Open radical prostatectomy provides excellent long-term oncologic control, but sparse short-term data are available for laparoscopic and robotic prostatectomy. Favorable outcomes also have been reported for urinary control and sexual function, regardless of approach. Additional prospective data collection is needed to evaluate if minimally invasive approaches provide distinct advantages over open surgery.
Topics: Costs and Cost Analysis; Humans; Laparoscopy; Male; Prostatectomy; Prostatic Neoplasms; Robotics; Treatment Outcome
PubMed: 16770855
DOI: 10.1007/s11934-006-0021-1 -
Urology Mar 2022To determine the incidence and predictive factors for conversion to an open procedure during Holmium Laser Enucleation of Prostate (HoLEP).
OBJECTIVE
To determine the incidence and predictive factors for conversion to an open procedure during Holmium Laser Enucleation of Prostate (HoLEP).
METHODS
A retrospective review was performed on files of all patients that underwent HoLEP at our institution between 2013 and 2020. Data collected included demographics, pre-operative estimated prostate size, intraoperative data, pathologic data, and functional baseline. A univariate and multivariate comparison between the pre-operative data of converted and un-converted cases was conducted.
RESULTS
Among a total of 807 HoLEP procedure performed during the above period, 20 cases were converted to open procedures (2.4%). Median pre-operative estimated prostate size in cases of conversion was 228ml compared to 95ml for unconverted cases (P <.001). The reasons for conversion were anatomical in 8 cases (40%), bleeding that was difficult to control endoscopically in 4 cases (20%), expected procedure to be too long due to large prostate size in 6 cases (30%), one case of morcellation technical malfunction, and one case with very large bladder stones not suitable for endoscopic treatment. Prostate size was the only factor that was found to be associated with conversion in univariate and multivariate analysis.
CONCLUSION
The risk of conversion of HoLEP to open procedures is size-dependent. The risk for conversion to open prostatectomy/cystotomy must be communicated to patients who choose HoLEP to improve the informed consent process and provide the highest quality of patient care and transparency. Open prostatectomy/cystotomy should be a part of the armamentarium of every HoLEP surgeon operating on large prostates.
Topics: Holmium; Humans; Laser Therapy; Lasers, Solid-State; Male; Prostate; Prostatectomy; Prostatic Hyperplasia; Transurethral Resection of Prostate; Treatment Outcome
PubMed: 34968568
DOI: 10.1016/j.urology.2021.12.010 -
Current Opinion in Urology May 2009Radical prostatectomy has evolved enormously over the last 25 years. Improvements include the use of smaller incisions, reduced blood loss, shorter hospital stays, and... (Review)
Review
PURPOSE OF REVIEW
Radical prostatectomy has evolved enormously over the last 25 years. Improvements include the use of smaller incisions, reduced blood loss, shorter hospital stays, and surgical refinement to improve the recovery of continence and potency. In addition, new technologies and minimally invasive techniques with the potential to further improve patient outcomes have been introduced. This article focuses on outcomes with open radical prostatectomy and is not meant to compare open radical prostatectomy and minimally invasive approaches.
RECENT FINDINGS
Despite a lack of randomized controlled trials, strong observational cohort studies demonstrate lower rates of positive surgical margins, high 10-year and 15-year biochemical recurrence-free rates, excellent prostate cancer-specific mortality rates, and improved recovery of urinary incontinence and erectile function after open radical prostatectomy. We review publications from the past 24 months regarding oncologic outcome, continence, and erectile function, as well as some earlier manuscripts that emphasize key aspects of open radical prostatectomy.
SUMMARY
Today open radical prostatectomy is a less-invasive procedure with low morbidity providing excellent control of clinically localized prostate cancer. Although open radical prostatectomy now accounts for a minority of radical prostatectomies in the United States, the concepts that have improved oncologic and quality-of-life outcomes are equally applicable to minimally invasive procedures.
Topics: Erectile Dysfunction; Humans; Male; Patient Satisfaction; Prostatectomy; Prostatic Neoplasms; Quality of Life; Treatment Outcome; Urinary Incontinence
PubMed: 19365894
DOI: 10.1097/mou.0b013e328329eb13 -
Der Urologe. Ausg. A Mar 2018
Review
Topics: Humans; Male; Prostatectomy; Prostatic Neoplasms
PubMed: 29460171
DOI: 10.1007/s00120-018-0600-z