Is previous experience in laparoscopic necessary to perform robotic radical prostatectomy? A comparative study with robotic and the classic open procedure in patients with prostate cancer

Abstract

PURPOSE:To assess comparative results of robot-assisted radical laparoscopic prostatectomy (RARP) performed by surgeons without any experience in laparoscopic prostatectomy and the open procedure performed by surgeons with large experience. METHODS:We analyzed 84 patients (50 subjected to robotic surgery) from June 2012 to September 2013. Data were prospectively collected in a customized database. Two surgeons carried out all the RARP cases. These two surgeons and six more performed the open cases. The perioperative outcomes between the two groups were analyzed with a minimum followup of 12 months. RESULTS:The corporal mass index (BMI) was higher in the open group (p=0.001). There was more operatve time, less hospitalization and blood loss, better trifecta and pentafecta and earlier continence (p=0.045) in the robotic group (p=0.001). There was no difference in positive surgical margins but with greater extraprostatic extension in the open group (p=0.002). CONCLUSIONS:Robot-assisted radical prostatectomy is a safe procedure even in the hands of surgeons with no previous experience.Besides this, better operative outcomes can be reached with this modern approach.

Prospective evaluation of vesicourethral anastomosis outcomes in robotic radical prostatectomy during early experience in a university hospital

“…In the first reported series in Brazil, Colombo Jr et al reported mean estimated bleeding of 480mL (100-1800) and transfusion necessary in two patients (2%). One study from Tobias-Machado and another from Lott found mean blood loss of 245.6mL and 212mL respectively ( 21 , 22 ). In our series, mean EBL was 95mL (±158), no patients had blood transfusions during surgery, but two (3.3%) required it during postoperative period.…”

“…Reports from initial series in some high volume centers showed median surgical duration from 215 to 274 minutes ( 24 , 25 ). Series from our country reported mean or median surgical times from 175 to 298 minutes ( 3 , 21 , 22 , 26 ). In 2005 Patel et al described an extremely short mean operative time of 141 min.…”

“…One report from Brazil found 6 months continence rates of 93.3% ( 21 ). Lott et al described continence rates of 88% in 6 months ( 22 ). Considering the criterion of continence up to 1 security pad, the present series showed 90% continence at 6 months.…”

Challenges and opportunities in prostate cancer surgery in South America: Insights into robot‐assisted radical prostatectomies—A perspective

“…Another noteworthy finding is the potential for a shorter learning curve and less demanding training programs for surgeons adopting RARP in Brazil. 13 This suggests that urologists in South America may require fewer rigorous training requirements to develop proficiency in RARP. Despite these advantages, several challenges prevent the widespread adoption of RARP in South America.…”

“…Preliminary studies have consistently demonstrated advantages associated with RARP, such as reduced blood transfusions, fewer intraoperative complications (transfusion, difficult airway, low-potency vasopressor, bleeding, anesthetic complications, and conversion to laparotomy), and postoperative complications (nausea and vomiting, urinary incontinence), along with decreased perioperative deaths. 8,9,[11][12][13][14][15] Additionally, patients undergoing RARP have reported superior outcomes in terms of urinary continence and preservation of erectile function. [11][12][13][14] These benefits not only enhance patients' quality of life and sexual satisfaction but also reduce the need for postoperative sexual health consultations, thereby contributing to resource preservation.…”