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Journal of Robotic Surgery Apr 2023We aimed to report a comprehensive outcome analysis of robot-assisted laparoscopic prostatectomies (RALP) performed by a single surgeon and compared it to retropubic... (Review)
Review
We aimed to report a comprehensive outcome analysis of robot-assisted laparoscopic prostatectomies (RALP) performed by a single surgeon and compared it to retropubic radical prostatectomies (RRP) done by the same surgeon in a high-volume center. Preoperative, perioperative, and postoperative data were collected prospectively and compared with retrospective retropubic radical prostatectomy data. Perioperative, oncological data, and functional results in the first year were compared between the two groups. There were 547 RARPs between 4th August 2011 and 31st December 2018, and 428 RRPs between 1st January 1996 and 31st December 2009 which were included in this review. While the operation time was in favour of the open group (196 vs 160 min, p < 0.01), the estimated blood loss (188 vs 316 ml, p < 0.01), blood transfusion rate (3% vs 7%, p = 0.021), hospital stay (4 days vs 7 days), and mean catheter duration (12 vs 15 days) were in favour of the robotic group. Majority of the complications belonged to Clavien-Dindo group II in both groups and the rates were not significantly different (p = 0.33). The 12-month continence rate was in favour of the RALP group (98.3% vs 99.2%, p < 0.01). Overall survival of the RALP cohort at 24 months was 99.8%, 60 months 96.1%, 84 months 87.3%, 96 months 81.3%), and 108 months was 79.5%. Overall survival at 24 months was 99.8%, 60 months 96.1%, 84 months 87.3%, 96 months 81.3%, and 108 months 79.5%. RALP is a safe, minimally invasive, technically feasible procedure with comparable functional and oncological outcomes. Our study showed superior perioperative and continence outcomes in RALP. However, despite its growing popularity, RRP still remains the gold standard in India due to its affordability and accessibility.
Topics: Male; Humans; Robotics; Robotic Surgical Procedures; Retrospective Studies; Prostatectomy; Surgeons; Laparoscopy; Treatment Outcome
PubMed: 36306101
DOI: 10.1007/s11701-022-01479-6 -
Urology Mar 2021To compare symptomatic lymphocele rates between standard and Retzius sparing prostatectomy approaches.
OBJECTIVE
To compare symptomatic lymphocele rates between standard and Retzius sparing prostatectomy approaches.
METHODS
From September 18, 2019 to July 15, 2020, robot assisted laparoscopic prostatectomies by 2 surgeons (1 using SP and other Xi) at a single institution were retrospectively reviewed. Symptomatic lymphoceles were diagnosed after the patient represented to the hospital with symptoms attributable to lymphocele and confirmed by abdominal CT scan. Statistical analysis was performed using R Studio (1.2).
RESULTS
There were 81 prostatectomies performed during the study period. Of these, 50 were Retzius sparing and 31 were standard approach. The 2 groups were similar in age, BMI, grade group, nerves spared, and T stage. Retzius sparing prostatectomies had higher lymph node yield and were more often performed with Xi multiport. Symptomatic lymphoceles were entirely present in the Retzius sparing group, occurring in 18% of cases at a mean time of 34 days after surgery. Retzius sparing approach was a significant predictor of lymphocele occurrence with an odds ratio of 23.77 (95% CI, 2-3725).
CONCLUSION
Retzius sparing prostatectomy was a significant predictor of symptomatic lymphoceles. Most of these cases required IR drainage and IV antibiotics as treatment. This is likely due to impairment of lymph reabsorption as the peritoneal lining remains approximated during Retzius sparing prostatectomy.
Topics: Administration, Intravenous; Anti-Bacterial Agents; Drainage; Humans; Lymphocele; Male; Middle Aged; Organ Sparing Treatments; Postoperative Complications; Prostatectomy; Prostatic Neoplasms; Retrospective Studies; Robotic Surgical Procedures
PubMed: 33279613
DOI: 10.1016/j.urology.2020.11.032 -
Actas Urologicas Espanolas Jun 2007To report the outcomes of 100 robotically assisted laparoscopic radical prostatectomies (RALPs), a minimally invasive alternative for treating prostate cancer. (Review)
Review
OBJECTIVE
To report the outcomes of 100 robotically assisted laparoscopic radical prostatectomies (RALPs), a minimally invasive alternative for treating prostate cancer.
PATIENTS AND METHODS
In all patients was used RALP with an extraperitoneal approach assisted by the da Vinci robotic surgical system (Intuitive Surgical, Sunnyvale, CA, USA). Prospective data collection included quality-of-life questionnaires, basic demographics (height, weight and body mass index), prostate specific antigen (PSA) levels, clinical stage and Gleason grade. Variables assessed during RALP were operative duration, estimated blood loss (EBL) and complications, and after RALP were hospital stay, catheter time, pathology, PSA level, return of continence and potency.
RESULTS
The mean (range) duration of RALP was 180 (140-295) min; all procedures were successful, with no intraoperative transfusions or deaths. The mean EBL was 300 mL (40-1100); 97% of patients were discharged home on the first day after RALP with a mean haematocrit of 36%. The mean duration of catheterization was 7 (5-21) days. The positive margin rate was 14% for all patients. The overall biochemical recurrence free (PSA level < 0.1 ng/mL) survival was 95% at mean follow-up of 9.7 months. There was complete continence at 6 months in 95% of patients. At 1 year 78% of patients were potent (with or without the use of oral medications), 15% were not yet able to sustain erections capable of intercourse, and another 7% still required injection therapy.
CONCLUSION
RALP is a safe, feasible and minimally invasive alternative for treating prostate cancer. Our initial experience with the procedure shows promising short-term outcomes.
Topics: Adenocarcinoma; Adult; Aged; Humans; Laparoscopy; Male; Middle Aged; Minimally Invasive Surgical Procedures; Prostatectomy; Prostatic Neoplasms; Retrospective Studies; Robotics
PubMed: 17896553
DOI: 10.1016/s0210-4806(07)73693-8 -
Urology Feb 2004To assess the incidence of, and risk factors for, inguinal hernia after retropubic radical prostatectomy compared with after pelvic lymph node dissection and total... (Comparative Study)
Comparative Study Review
OBJECTIVES
To assess the incidence of, and risk factors for, inguinal hernia after retropubic radical prostatectomy compared with after pelvic lymph node dissection and total cystectomy.
METHODS
A total of 155 radical prostatectomies, 35 pelvic lymph node dissections, and 56 total cystectomies were included in this study. We reviewed the charts retrospectively and evaluated the incidence of, and risk factors for, inguinal hernia after surgery using Kaplan-Meier plots and a Cox proportional hazard model.
RESULTS
Of 155 patients in the radical prostatectomy group, 35 patients in the pelvic lymph node dissection group, and 56 patients in the cystectomy group, 33 (21.3%), 4 (11.4%), and 3 (5.4%), respectively, developed inguinal hernias during follow-up. In the radical prostatectomy group, 27 (81.8%) of the 33 patients developed inguinal hernia within 2 years postoperatively. Multivariate Cox proportional hazard analysis revealed that prostatectomy group, past history of inguinal hernia, and body mass index of less than 23 were significant risk factors for postoperative inguinal hernia.
CONCLUSIONS
The incidence of inguinal hernia after radical prostatectomy is not low. Urologists should realize that inguinal hernia is one of the major complications of radical prostatectomy and examine the groin preoperatively and postoperatively.
Topics: Aged; Aged, 80 and over; Cystectomy; Hernia, Inguinal; Humans; Incidence; Life Tables; Lymph Node Excision; Male; Middle Aged; Pelvis; Postoperative Complications; Proportional Hazards Models; Prostatectomy; Recurrence; Retrospective Studies; Risk Factors; Urinary Diversion
PubMed: 14972471
DOI: 10.1016/j.urology.2003.09.038 -
Annales D'urologie Oct 2006There is a lack of prospective randomised trials comparing the efficacy of the different techniques for treating localised prostate cancer. Consequently, selecting one... (Review)
Review
There is a lack of prospective randomised trials comparing the efficacy of the different techniques for treating localised prostate cancer. Consequently, selecting one rather than the other appears very difficult. Even radical prostatectomy is controversial regarding its best approach--perineal, retropubic or laparoscopic. The perineal route was the first to be undertaken, and it was dropped out due to the need of performing obturator lymphadenectomy by a separate approach. Widespread use of prostate-specific antigen as a screening method has enabled to diagnose prostate cancer at its early stages, when the potential for lymphatic dissemination is low, which enables to obviate Lymphadenectomy in most patients. This was a promoting circumstance to use the perineal route in radical prostatectomies. In this article we discuss the perineal radical prostatectomy surgical technique, its indications, and its advantages and disadvantages as compared to other approaches.
Topics: Humans; Male; Perineum; Prostatectomy; Prostatic Neoplasms
PubMed: 17100168
DOI: 10.1016/j.anuro.2006.06.001 -
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 -
Urologic Oncology Apr 2013Prostate cancer remains a significant health problem worldwide and is the second highest cause of cancer-related death in men. While there is uncertainty over which men... (Review)
Review
Prostate cancer remains a significant health problem worldwide and is the second highest cause of cancer-related death in men. While there is uncertainty over which men will benefit from radical treatment, considerable efforts are being made to reduce treatment related side-effects and in optimizing outcomes. The current gold standard treatment for localized prostate cancer remains open radical prostatectomy. Since the early 1990s, several teams have tried to explore less invasive surgical access. The first robotically assisted laparoscopic prostatectomy (RALP) case was reported in 2000. Enhancement of the ergonomics and optimization of the surgical vision provided by the robotic interface are some of the reasons that explain the worldwide wide spread of RALP. Although this procedure accounted for the vast majority of radical prostatectomies performed in United States, its diffusion is still limited in Europe. The cost for robot purchase and maintenance are obvious limiting factors for its expansion. According to the literature, the operating time and the blood loss are, once the learning curve is completed, similar to those of open or laparoscopic procedures. Hospital stay and time before bladder catheter removal are shorter compared with other approaches. Intermediate oncologic and functional outcomes do not show difference with the open or laparoscopic results. Given that these data are encouraging, the limited follow-up with RALP does not allow drawing any definitive statement in comparison with conventional techniques. The aim of our study was to underline the perioperative, oncologic, and functional outcomes of all extraperitoneal RALP series published.
Topics: Humans; Laparoscopy; Length of Stay; Male; Prostate; Prostatectomy; Prostatic Neoplasms; Reproducibility of Results; Robotics; Treatment Outcome
PubMed: 20864364
DOI: 10.1016/j.urolonc.2010.07.004 -
Wiadomosci Lekarskie (Warsaw, Poland :... 2023The aim: To evaluate whether simultaneous inguinal hernioplasty during prostatectomy confers benefits on quality-of-life outcomes.
OBJECTIVE
The aim: To evaluate whether simultaneous inguinal hernioplasty during prostatectomy confers benefits on quality-of-life outcomes.
PATIENTS AND METHODS
Materials and methods: 152 patients with prostatic adenoma were observed. The general group included 32 (21%) patients with prostatic adenoma and hernia inguinalis, who underwent one-stage prostatectomy accompanied with hernioplasty. 120 (79%) persons of comparison group underwent a prostatectomy only. The average age of the comparison group was 68.0±7.0 years, the general group - 67.1±6.9 years; the average prostate volume was 94.4±42.3 cm3 and 91.2±32.6 cm3 respectively. Hernia inguinalis was in 32 patients of the general group, in 4 of them - on both sides (36 cases totally).
RESULTS
Results: The average time of retropubic prostatectomy in both groups was the same, and simultaneous hernioplasty took 35.0±17.4 minutes. The frequency of early and late bleeding after prostatectomies in the general group was 6.25% (2 cases) and 7.5% (9 cases) in the comparison group. No deaths were noted in two groups. The quality-of-life outcomes after the one-stage prostatectomy accompanied with hernioplasty in 6 and 12 months were statistically better than before these operations.
CONCLUSION
Conclusions: Performing one-stage prostatectomy accompanied with hernioplasty does not worsen the immediate and long-term results of operation, instead it helps to eliminate two diseases at the same time from one surgical approach.
Topics: Male; Humans; Middle Aged; Aged; Herniorrhaphy; Prostatic Hyperplasia; Prostatic Neoplasms; Prostatectomy; Hernia, Inguinal; Quality of Life; Surgical Mesh
PubMed: 38290023
DOI: 10.36740/WLek202312108 -
Progres En Urologie : Journal de... Mar 2017Despite a decreasing number of radical prostatectomies in France, the number of robot-assisted surgeries increases. The objective of this work is to assess the interest... (Review)
Review
INTRODUCTION
Despite a decreasing number of radical prostatectomies in France, the number of robot-assisted surgeries increases. The objective of this work is to assess the interest of robotic prostatectomy before asking a specific funding from health authorities.
MATERIAL AND METHODS
A systematic review of the literature on PubMed was performed. Prospective studies and meta-analyses comparing robot-assisted radical prostatectomy (RARP), laparoscopic (LRP) and open surgery (OP) were selected.
RESULTS
There are only two randomized clinical trials comparing RARP and LRP. Erectile function was significantly better after RARP than after LRP. Compared to OP, sexuality evaluation, based on meta-analyses, was significantly better at 12 months and the absolute risk of erectile dysfunction significantly decreased. Continence after RARP was significantly better than LRP 3 months after surgery. Compared to OP, continence results were discordant, sometimes significantly in favor of RARP, sometimes similar. The rate of positive margins was similar whatever the technique. The long-term oncological outcomes were similar. In terms of perioperative complications, no significant difference was observed between RARP and LRP or OP.
CONCLUSION
RARP provides same oncological outcomes as the open and laparoscopic approach. Continence and sexuality are better after RARP than after laparoscopic or open surgery. However, no randomized study comparing RARP and OP is available.
Topics: Erectile Dysfunction; Humans; Laparoscopy; Male; Prostatectomy; Prostatic Neoplasms; Robotic Surgical Procedures; Urinary Incontinence
PubMed: 28169123
DOI: 10.1016/j.purol.2016.12.010 -
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