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Urologia Internationalis 2016To assess clinical outcomes and reimbursement costs of open and robotic-assisted radical prostatectomies in Germany. (Comparative Study)
Comparative Study
PURPOSE
To assess clinical outcomes and reimbursement costs of open and robotic-assisted radical prostatectomies in Germany.
METHODS
Perioperative data of 499 open (2003-2006) and 932 (2008-2010) robotic-assisted radical prostatectomies as well as longitudinal reimbursement costs of an anonymized health insurance research database from Germany containing data of patients who underwent robotic-assisted or open radical prostatectomy were retrospectively analysed in a single-centre study.
RESULTS
Significantly better outcomes after robotic-assisted vs. open prostatectomy were observed in regards to positive surgical margins (13.3 vs. 22.4%; p < 0.0001), intraoperative transfusions (0.1 vs. 2.6%; p < 0.0001), hospitalization (8.7 vs. 15.2 days; p < 0.0001) and duration of catheter (6.6 vs. 12.8 days; p < 0.0001). Operating time was significantly longer with robotic-assisted radical prostatectomy when compared to open surgery (184.4 vs. 128.0 min; p < 0.0001), while intraoperative complications showed a similar occurrence between both groups. Significant fewer postoperative complications were observed after robotic-assisted radical prostatectomy (26.5 vs. 42.5%; p < 0.0001) and rate of re-admission was lower for the robotic patients (13.6 vs. 19.4%; p = 0.0050). While insurance costs were higher in the 2 years before radical prostatectomy for the patients who underwent a robotic procedure (4,241.60 vs. 3,410.23 €; p = 0.202), additive costs of care of the year of surgery plus the 2 following years were less for the robotic cohort when compared to the costs incurred by the open group (21,673.71 vs. 24,512.37 €; p = 0.1676).
CONCLUSIONS
The observed clinical advantages of robotic-assisted radical prostatectomy seem to result in reduced health insurance cost postoperatively when compared to open surgery. This should be taken into consideration regarding reimbursement and implementation of a clinically superior method.
Topics: Aged; Catheterization; Germany; Health Care Costs; Humans; Insurance, Health; Intraoperative Period; Laparoscopy; Length of Stay; Male; Middle Aged; Operative Time; Perioperative Period; Postoperative Complications; Prostate; Prostatectomy; Prostatic Neoplasms; Retrospective Studies; Robotic Surgical Procedures; Treatment Outcome
PubMed: 26159050
DOI: 10.1159/000431104 -
Andrology Jan 2018Neglected side effects after radical prostatectomy have been previously reported. In this context, the prevalence of penile morphometric alterations has never been...
Neglected side effects after radical prostatectomy have been previously reported. In this context, the prevalence of penile morphometric alterations has never been assessed in robot-assisted radical prostatectomy series. We aimed to assess prevalence of and predictors of penile morphometric alterations (i.e. penile shortening or penile morphometric deformation) at long-term follow-up in patients submitted to either robot-assisted (robot-assisted radical prostatectomy) or open radical prostatectomy. Sexually active patients after either robot-assisted radical prostatectomy or open radical prostatectomy prospectively completed a 28-item questionnaire, with sensitive issues regarding sexual function, namely orgasmic functioning, climacturia and changes in morphometric characteristics of the penis. Only patients with a post-operative follow-up ≥ 24 months were included. Patients submitted to either adjuvant or salvage therapies or those who refused to comprehensively complete the questionnaire were excluded from the analyses. A propensity-score matching analysis was implemented to control for baseline differences between groups. Logistic regression models tested potential predictors of penile morphometric alterations at long-term post-operative follow-up. Overall, 67 (50%) and 67 (50%) patients were included after open radical prostatectomy or robot-assisted radical prostatectomy, respectively. Self-rated post-operative penile shortening and penile morphometric deformation were reported by 75 (56%) and 29 (22.8%) patients, respectively. Rates of penile shortening and penile morphometric deformation were not different after open radical prostatectomy and robot-assisted radical prostatectomy [all p > 0.5]. At univariable analysis, self-reported penile morphometric alterations (either penile shortening or penile morphometric deformation) were significantly associated with baseline international index of erectile function-erectile function scores, body mass index, post-operative erectile function recovery, year of surgery and type of surgery (all p < 0.05). At multivariable analysis, robot-assisted radical prostatectomy was independently associated with a lower risk of post-operative penile morphometric alterations (OR: 0.38; 95% CI: 0.16-0.93). Self-perceived penile morphometric alterations were reported in one of two patients after radical prostatectomy at long-term follow-up, with open surgery associated with a potential higher risk of this self-perception.
Topics: Aged; Humans; Long Term Adverse Effects; Male; Middle Aged; Penis; Postoperative Complications; Prostatectomy; Robotic Surgical Procedures
PubMed: 29195014
DOI: 10.1111/andr.12446 -
Gan To Kagaku Ryoho. Cancer &... Jul 2012Robot-assisted radical prostatectomy(RARP)has emerged in the last decade. It has greatly improved clinical management of localized prostate cancer. Its use has been... (Review)
Review
Robot-assisted radical prostatectomy(RARP)has emerged in the last decade. It has greatly improved clinical management of localized prostate cancer. Its use has been justified by its satisfactory oncological and functional outcomes and its fewer perioperative complications. RARP has the advantages of both conventional open radical retropubic prostatectomy and laparoscopic radical prostatectomy. However, its increased cost and the lack of tactile sensation it induces still remain problems.
Topics: Humans; Male; Postoperative Complications; Prostatectomy; Prostatic Neoplasms; Robotics
PubMed: 22790035
DOI: No ID Found -
The Journal of Urology May 2003There is an ongoing debate about the benefits of laparoscopic radical prostatectomy compared to the open retropubic approach. We compared the last 219 patients treated... (Comparative Study)
Comparative Study
PURPOSE
There is an ongoing debate about the benefits of laparoscopic radical prostatectomy compared to the open retropubic approach. We compared the last 219 patients treated with open retropubic prostatectomy with 438 patients treated with laparoscopic radical prostatectomy at our institution, focusing on operative data, complications and mid-term outcome.
MATERIALS AND METHODS
From December 1994 to November 1999 a total of 219 patients were treated with open prostatectomy and pelvic lymph node dissection (group 1). From March 1999 to September 2002, 219 patients underwent early (group 2) and 219 underwent late (group 3) laparoscopic radical prostatectomy and pelvic lymph node dissection. The same surgeons performed both operations. All 3 groups were similar with respect to mean patient age, mean prostate specific antigen value, median Gleason score, previous transurethral resection of the prostate and neoadjuvant treatment, although there was a slight stage shift in favor of the 2 laparoscopic groups.
RESULTS
Mean operating time was significantly shorter after open surgery (196 minutes) compared to the early laparoscopic group (288) but it did not differ significantly from the late laparoscopic group (218). Mean blood loss (1,550 versus 1,100 versus 800 cc) and transfusion rates (55.7% versus 30.1% versus 9.6%) in groups 1 to 3 favored the laparoscopic groups. The complication rate in groups 1 to 3 was lower for laparoscopy (19.2% versus 13.7% versus 6.4%), but the spectrum differed. The early laparoscopic group had a higher incidence of rectal injuries (1.8% versus 3.2% versus 1.4% in groups 1 to 3, respectively) and urinary leakage (0.5% versus 2.3% versus 0.9%), whereas more lymphoceles (6.9% versus 0% versus 0%), wound infection (2.3% versus 0.5% versus 0%), embolism/pneumonia (2.3% versus 0.5% versus 0.5%) and anastomotic strictures (15.9% versus 6.4% versus 4.1%) occurred after open surgery. The amount of postoperative analgesia was significantly greater after open surgery (50.8 versus 33.8 versus 30.1 mg. in groups 1 to 3, respectively). Median catheter time was longer after open retropubic prostatectomy (12 versus 7 versus 7 days in groups 1 to 3, respectively) but the continence rates were similar in all 3 groups at 12 months (89.9% versus 90.3% versus 91.7%). The rate of positive margins did not differ significantly in groups 1 to 3 (28.2% versus 21.0% versus 23.2%), prostate specific antigen recurrence was equivalent related to the different observation periods.
CONCLUSIONS
Laparoscopic radical prostatectomy is technically demanding, with an initially longer operative time, higher incidence of rectal injuries and urinary leakage. The overall outcome after 219 cases favors the laparoscopic approach. Consequently, at our institution laparoscopic radical prostatectomy has become the method of choice.
Topics: Adult; Aged; Aged, 80 and over; Humans; Laparoscopy; Male; Middle Aged; Postoperative Complications; Prostatectomy; Prostatic Neoplasms
PubMed: 12686809
DOI: 10.1097/01.ju.0000062614.56629.41 -
Urologia Internationalis 2022Injuries to surrounding structures during radical prostatectomy (RP) are rare but serious complications. However, it remains unknown if injuries to intestines, rectum,... (Comparative Study)
Comparative Study
INTRODUCTION
Injuries to surrounding structures during radical prostatectomy (RP) are rare but serious complications. However, it remains unknown if injuries to intestines, rectum, or vascular structures occur at different rates depending on the surgical approach.
METHODS
We compared the frequency of these outcomes in open RP (ORP) and minimally invasive RP (MIS-RP) using the national American College of Surgeons National Surgical Quality Improvement Program database (2012-2017). Along with important metrics of clinical and surgical outcomes, patients were identified as undergoing surgical repair of small or large bowel, vascular structures, or hernias based on Current Procedural Terminology codes.
RESULTS
In our propensity matched analysis, a total of 13,044 patients were captured. Bowel injury occurred more frequently in ORP than in MIS-RP (0.89 vs. 0.26%, p < 0.01). By intestinal segment, rectal and large bowel injuries were more common in ORP than MIS-RP (0.41 vs. 0.11% and 0.31 vs. 0.05%, both p < 0.01). However, there was no statistically significant difference between the groups for small bowel injury (0.17 vs. 0.11%, p = 0.39). Vascular injury was more common in MIS-RP (0.18 vs. 0.08%, p = 0.08). Hernias requiring repair were only identified in the MIS-RP group (0.12%).
CONCLUSION
When considering surgical approach, rectal and large bowel injuries were more common in ORP, while vascular injuries and hernia repair were more common in MIS-RP. Our findings can be used in counseling patients and identifying risk factors and strategies to reduce these complications.
Topics: Aged; Aged, 80 and over; Humans; Intestines; Intraoperative Complications; Male; Middle Aged; Minimally Invasive Surgical Procedures; Prostatectomy; Prostatic Neoplasms; Retrospective Studies
PubMed: 33902060
DOI: 10.1159/000515618 -
Urology Jul 2008Prostate cancer affects the lives of millions of Americans each year. Since the advent of prostate-specific antigen testing, many cancers are found in initial stages and... (Comparative Study)
Comparative Study Review
Prostate cancer affects the lives of millions of Americans each year. Since the advent of prostate-specific antigen testing, many cancers are found in initial stages and have the potential for curative resection; however, choosing which type of surgery to undergo can be a difficult task. This article reviews the outcomes of robotic prostatectomy in comparison with laparoscopic or open procedures. A PubMed search was performed to identify specific articles describing intraoperative details, surgical complications, cancer control, and continence and potency outcomes. Articles that revealed pertinent data were included in this study comparing robotic with laparoscopic or open prostatectomies.
Topics: Erectile Dysfunction; Humans; Laparoscopy; Male; Prostatectomy; Prostatic Neoplasms; Robotics; Treatment Outcome
PubMed: 18436288
DOI: 10.1016/j.urology.2007.12.038 -
Minerva Urologica E Nefrologica = the... Mar 2015Over the past decade, the robotic assisted radical prostatectomy (RARP) has grown increasingly popular and quickly equated itself as the most commonly used modality to... (Review)
Review
Over the past decade, the robotic assisted radical prostatectomy (RARP) has grown increasingly popular and quickly equated itself as the most commonly used modality to treat locally-confined prostate cancer. Despite increased utilization, there is limited comparative research demonstrating superiority for RARP over the conventional radical retropubic prostatectomy (RRP). Furthermore, though perioperative and short-term oncologic outcomes are equivalent if not superior for the robotic approach, the optimal utilization of robotic technology remains to be determined with cost serving as a primary driver. In this review, we performed a literature search to identify comparative effectiveness research as it pertains to RARP versus RRP. We performed a PubMed literature search for a review of articles published between 2000 and 2014 using the following keywords to identify pertinent research: "robot or robotic prostatectomy", "open or retropubic prostatectomy", "cost", "resource utilization". Long-term data comparing RARP and RRP remains limited, though short-term positive surgical margins, biochemical recurrence-free survival, and need for adjuvant therapy appear at least equivocal, if not in favor of RARP versus RRP. Functional outcomes including return of continence and potency favor RARP while cost still favors RRP. Nonetheless, the generalization of results remains difficult with surgeon volume playing a large role in improving efficiency and quality. For the foreseeable future, an increasing number of prostatectomies will continue to be performed robotically. Though RARP appears to offer improved functional outcomes with good short-term oncologic outcomes, there is a need for longer-term studies to assess the true value of RARP. Outcomes aside, rigorous, prospective randomized-controlled trials must also be performed on the cost-effectiveness of RARP to determine its overall utility in an era of health care delivery reform.
Topics: Cost-Benefit Analysis; Evidence-Based Medicine; Humans; Los Angeles; Male; Prostatectomy; Prostatic Neoplasms; Robotic Surgical Procedures; Treatment Outcome
PubMed: 25424387
DOI: No ID Found -
Mayo Clinic Proceedings Sep 2004The development of advanced laparoscopic techniques and robot-assisted technology has resulted in several new surgical approaches for treating organ-confined prostate... (Review)
Review
The development of advanced laparoscopic techniques and robot-assisted technology has resulted in several new surgical approaches for treating organ-confined prostate cancer. Outcomes with these new or minimally Invasive techniques should be assessed carefully to ensure that they are similar to or surpass patients' oncologic and functional outcomes after open radical prostatectomy. This article reviews the current published experience with minimally Invasive approaches to increase awareness about viability. Several of the larger series of patients who have undergone laparoscopic (transperitoneal and extraperitoneal) or robot-assisted laparoscopic radical prostatectomies are discussed and evaluated critically. Comparisons to published data on open radical prostatectomy are included for completeness. The different minimally invasive techniques are described and contrasted in regard to prostate-specific antigen progression-free survival, surgical margin status, blood loss, transfusion rates, postoperative pain, length of hospitalization, duration of urinary catheterization, potency, continence, and complications. The relative costs of each method are provided. The coexistence of multiple surgical approaches should and can challenge surgeons who perform open and minimally invasive procedures to strive for a new standard of care above and beyond what is accepted today to minimize patient morbidity while maximizing functional and oncologic outcomes.
Topics: Adult; Aged; Humans; Laparoscopy; Length of Stay; Male; Middle Aged; Pain, Postoperative; Postoperative Complications; Prostatectomy; Prostatic Neoplasms; Robotics
PubMed: 15357040
DOI: 10.4065/79.9.1169 -
The Journal of Urology Apr 2013The use of robot-assisted radical prostatectomy has increased rapidly despite the absence of randomized, controlled trials showing the superiority of this approach.... (Comparative Study)
Comparative Study
PURPOSE
The use of robot-assisted radical prostatectomy has increased rapidly despite the absence of randomized, controlled trials showing the superiority of this approach. While recent studies suggest an advantage for perioperative complication rates, they fail to account for the volume-outcome relationship. We compared perioperative outcomes after robot-assisted and open radical prostatectomy, while considering the impact of this established relationship.
MATERIALS AND METHODS
Using the NIS (Nationwide Inpatient Sample), we abstracted data on patients treated with radical prostatectomy in 2009. Univariable and multivariable logistic regression analyses were done to compare the rates of blood transfusion, intraoperative and postoperative complications, prolonged length of stay, increased hospital charges and mortality between robot-assisted and open radical prostatectomy overall and across volume quartiles.
RESULTS
An estimated 77,616 men underwent radical prostatectomy, including a robot-assisted and an open procedure in 63.9% and 36.1%, respectively. Low volume centers averaged 26.2 robot-assisted and 5.2 open cases, while very high volume centers averaged 578.8 robot-assisted and 150.2 open cases. Overall, patients treated with the robot-assisted procedure experienced a lower rate of adverse outcomes than those treated with the open procedure for all measured categories. Across equivalent volume quartiles robot-assisted radical prostatectomy outcomes were generally favorable. However, the open procedure at high volume centers resulted in a lower postoperative complication rate (OR 0.59, 95% CI 0.46-0.75), elevated hospital charges (OR 0.75, 95% CI 0.64-0.87) and a comparable blood transfusion rate (OR 1.38, 95% CI 0.93-2.02) relative to the robot-assisted procedure at low volume centers.
CONCLUSIONS
Regionalization has occurred to a greater extent for robot-assisted than for open radical prostatectomy with an associated benefit in overall outcomes. Nonetheless, low volume institutions experienced inferior outcomes relative to the highest volume centers irrespective of approach. These findings demonstrate the importance of accounting for hospital volume when examining the benefit of a surgical technique.
Topics: Aged; Hospitals, High-Volume; Hospitals, Low-Volume; Humans; Male; Middle Aged; Outcome and Process Assessment, Health Care; Postoperative Complications; Prostatectomy; Prostatic Neoplasms; Robotics
PubMed: 23085052
DOI: 10.1016/j.juro.2012.10.028 -
Therapeutische Umschau. Revue... Apr 2023Robot-assisted Simple Prostatectomy (RASP) Surgical treatment of large adenomas of the prostate (> 80g) in men suffering from symptomatic prostate hyperplasia is...
Robot-assisted Simple Prostatectomy (RASP) Surgical treatment of large adenomas of the prostate (> 80g) in men suffering from symptomatic prostate hyperplasia is challenging. Transurethral resection of the prostate (TUR-P), known as the operative gold standard, is not a safe option in large adenomas due to prolonged resection time and the consecutive increased complication rate. For decades, large adenomas were surgically treated by open enucleation. Although the procedure has still its role in surgical treatment of large glands, the perioperative morbidity and complications can be severe. In view of this fact, several new and minimal invasive techniques such as transurethral procedures, mainly using laser technologies (Holmiun-Laser Enucleation, HoLEP and KTP-Laser vaporization, Greenlight™ Laser), have been invented. In addition, the traditional open enucleation of the prostate was performed and evaluated by using conventional laparoscopy and finally by robot-assisted laparoscopy. Meanwhile robot-assisted simple prostatectomy (RASP) and especially its modification with an extraperitoneal extravesical access and intraprostatic reconstruction of the prostatic urethra in order to exclude the prostatic wound bed from the urinary tract with consecutive lower perioperative complication rates are well established procedures to treat large adenomas.
Topics: Male; Humans; Robotics; Transurethral Resection of Prostate; Prostatectomy; Prostatic Hyperplasia; Adenoma; Treatment Outcome
PubMed: 36975028
DOI: 10.1024/0040-5930/a001429