Differences in Patient Characteristics Among Men Choosing Open or Robot-Assisted Radical Prostatectomy in Contemporary Practice at a European High-Volume Center

Abstract

Objective: To examine the characteristics of robot-assisted radical prostatectomy (RARP) and open radical prostatectomy (ORP) patients at a high-volume center. Patients and Methods: We relied on the Martini-Clinic database and focused on prostate cancer patients treated in 2013. Characteristics in ORP and RARP patients were assessed. In multivariable logistic regression analyses (MVA), we predicted RARP treatment. Results: Of 1,920 patients, 575 (29.9%) underwent RARP and 1,345 (70.1%) ORP. RARP patients had a lower prostate-specific antigen (PSA), and were less likely to harbor pT3b, pathological Gleason ≥4 + 4 or lymph node metastases (all p < 0.05). Pelvic lymph node dissection (PLND) (84.3 vs. 87.0%, p = 0.1), as well as positive surgical margins (15.5 vs. 15.7%, p = 0.7) and the nerve-sparing status (p = 0.5) were comparable between RARP and ORP. Lymph node yield (median 11 vs. 16), and median blood loss (250 vs. 700 ml) were lower at RARP (all p < 0.001). Additionally, the median operating room time was higher at RARP (215 vs. 185 min, p < 0.001). In MVA, patients with body mass index (BMI) ≥30 were more likely to undergo RARP (OR 1.8, 95% CI 1.3-2.4, p < 0.001). Conversely, patients with PSA >20 ng/ml were less likely to undergo RARP (OR 0.6, 95% CI 0.4-1.0, p = 0.03). Conclusions: More favorable pathological characteristics were recorded at RARP. High BMI and low PSA were independent predictors for RARP. Treatment characteristics such as PLND rates, margin status and nerve sparing were comparable between RARP and ORP. Despite lower blood loss at RARP, a longer operating room time and lower yield of lymph nodes were recorded.

Utilization and Surgical Skill Transferability of the Simulator Robot to the Clinical Robot for Urology Surgery

“…A thorough literature review has identified a need for future studies to investigate operation-specific training, in conjunction with skills-based teaching in a more realistic augmented reality environment [26] . Moreover, it is important to incorporate teamwork, decision-making, and communication skills as these skills directly influence the overall performance of the trainees [26,27] .…”

“…Moreover, it is important to incorporate teamwork, decision-making, and communication skills as these skills directly influence the overall performance of the trainees [26,27] . Last but not least, when defining the validity of a virtual machine, more standardized definitions should be established across the different validities, such as face validity or concurrent validity.…”

Differences in Patient Characteristics among Men Choosing Open or Robot-Assisted Radical Prostatectomy in Contemporary Practice - Analysis of Surveillance, Epidemiology, and End Results Database

“…Additionally, RARP is at least equivalent [5] if not superior [6] to ORP in terms of margin rates [7] . Moreover, the advantage of pelvic lymph node dissection (PLND) extent and/or yield at RARP vs. ORP is also being debated [8,9] . For example, population-based studies observed an underuse of PLND at RARP [10,11] .…”

Impact of Surgeon and Hospital Volume on the Safety of Robot-Assisted Radical Prostatectomy: A Multi-Institutional Study Based on a National Database

“…The advantages of RARP, such as pneumoperitoneum, 3-dimensional visualization, and multiple-axis robot with 7 degrees of freedom, provide favorable surgical outcomes [1] . In addition, RARP tends to be performed more than open radical prostatectomy (ORP) under some situations [2,3] . The use of RARP has increased annually since it was first performed in December 2006, in Japan.…”