Prospective comparison of radical retropubic prostatectomy and robot-assisted anatomic prostatectomy: the Vattikuti Urology Institute experience.

摘要

OBJECTIVES: Robotic assistance may enhance the precision of anatomic dissection and increase the feasibility of performing laparoscopic radical prostatectomy for most surgeons. We performed a prospective comparison of 30 consecutive patients undergoing conventional radical retropubic prostatectomy (RRP) and 30 initial patients undergoing robot-assisted anatomic prostatectomy (RAP) at our institution. METHODS: The study design was a prospective nonrandomized comparison of anatomic RRP performed using the technique of Walsh and RAP performed with the da Vinci surgical system. We evaluated the baseline patient and tumor characteristics (age, body mass index, serum prostate-specific antigen, Gleason score, and clinical stage), intraoperative parameters (operative time, blood loss, and need for transfusion), postoperative parameters (pain score, hospitalization duration, catheter duration), histopathologic parameters, and complications in the two groups. RESULTS: The preoperative parameters were comparable for both groups of patients. The mean setup time for RAP was 0.95 hours. The mean operating time was 2.3 hours for RRP and 4.8 hours for RAP (P <0.001). One patient required conversion from RAP to RRP because of a lack of progress. The mean blood loss was 970 mL for RRP and 329 mL for RAP (P <0.001). The drop in hemoglobin was greater in the RRP group (4.4 versus 1.2 g in RAP; P <0.05). The mean pain score on postoperative day 1 was 7 in the RRP group and 4 in RAP group (P = 0.05). The mean hospital stay was 56 hours in the RRP group and 36 hours in the RAP group (P value not significant). Sixty-three percent of the RAP and 0% of the RRP groups were discharged within 23 hours (P <0.001). The mean duration of postoperative catheterization was 14 days for the RRP and 11 days for the RAP groups (difference not significant). The pathologic stage, margin status, and prostate-specific antigen values were not different between the two groups. The setup time, operative time, blood loss amount, and catheterization duration were significantly reduced after the first 20 patients. CONCLUSIONS: Currently, RAP is a longer procedure than RRP. However, the blood loss is minimal and patients feel less pain and are discharged earlier from the hospital. In our hands, the margin status and complication rates were comparable for both techniques.