How May Longer Console Times Influence Outcomes after Robot-Assisted Radical Prostatectomy (RARP)?

Abstract

Longer operating time in radical prostatectomy may increase the risk of perioperative complications. Various factors such as cancer extent, the procedure’s level of difficulty, habitus and previous surgeries may lengthen robot-assisted radical prostatectomy (RARP) and therefore compromise outcomes. Objective: this study investigates the influence of operating time on outcomes after RARP in real life settings in a monocentric single surgeon study. Methods: a total of 500 sequential patients who were operated on between April 2019 and August 2022 were involved. Men were allocated to three groups short (n = 157; 31.4%), under or equal to 120 min; average (n = 255; 51%), between 121 and 180 min; long (n = 88; 17.6%), above 180 min console time. Demographic, baseline and perioperative data were analyzed and compared between groups. Univariate logistic regression was completed to investigate the association between console time and outcomes and to predict factors which may prolong surgery. Results: hospital stay and catheter days were significantly longer in group 3 with medians of 6 and 7 days (p < 0.001 and <0.001, respectively). Those findings were confirmed in univariate analysis, with p = 0.012 for catheter days and p < 0.001 for hospital stay. Moreover, major complications were higher in patients with longer procedures, at p = 0.008. Prostate volume was the only predictor of a prolonged console time (p = 0.005). Conclusion: RARP is a safe procedure and most patients will be discharged uneventfully. Yet, a longer console time is associated with a longer hospital stay, longer catheter days and major complications. Caution has to be taken in the large prostate to avoid longer procedures, which may prevent postoperative adverse events.

How Might the Number of Lymph Nodes Removed during RARP Impact the Postoperative Outcomes?

“…Briganti et al [ 13 ] reasoned that if a PLND is indicated, then it should be extended, and in low-risk PCa, a staging ePLND might be spared. In our practice, we perform pelvic lymph adenectomy in all patients to prevent the risk of under-staging or under-grading due to the high rate of tumor misclassification from referring centers [ 14 ]. We abstained from further discrimination between standard and extended since it did not result in any clinical implications in our cohort, in which all patients received an extended PLND.…”

“…Yet none of them had concurrent lymphocele. Nonetheless thromboembolic events are linked to longer OR-time [ 14 ], the least mentioned it prolonged by extended lymph adenectomy.…”

"Single-Surgeon" versus "Dual-Surgeon" Robot-Assisted Radical Prostatectomy and Pelvic Lymph-nodes Dissection: Comparative Analysis of Perioperative Outcomes

“…Finally, longer operative time during RARP is reported to be associated with longer hospitalization, longer catheterization, and higher likelihood of adverse events. This is why we believe that anything that can be done for reducing the operating time should be welcome ( 19 ).…”