Robot-Assisted Laparoscopic Radical Prostatectomy: Oncologic and Functional Results of 184 Cases

Mottrie, Alexandre; Migem, P. Van; Naeyer, Geert De; Schatteman, Peter; Carpentier, Paul; Fonteyne, E.

doi:10.1016/j.eururo.2007.02.029

Cited by 101 publications

(61 citation statements)

References 21 publications

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“…These rates were consistent with the data of previous RALP series [10,[18][19][20][21]23,25]. We think that the SM status of our series is accurate; during RALP, the lateral neurovascular bundle dissection and the apical transection are done without electrocautery, to reduce the cautery artefact.…”

Section: Discussionsupporting

confidence: 79%

“…The complication rate was also low (8.8%) with no life-threatening complications, confirming that RALP is a safe and reproducible procedure [20]. The mean length of hospital stay was 4 days and comparable with other European series [18,23]. North-American series reported a shorter duration of hospitalization, essentially explained by varying international hospital practice [10,19,22,24].…”

Section: Discussionsupporting

confidence: 56%

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Robot‐assisted extraperitoneal laparoscopic radical prostatectomy: experience in a high‐volume laparoscopy reference centre

et al. 2010

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surgeon were distributed into five groups according to the chronological order of the procedures. The mean follow-up after RALP was 18.3 months. Patient demographics, surgical data and postoperative variables were collected into a prospective database. Data were compared by chronological groups into single-surgeon cohort. RESULTSThe median operative time and blood loss were 140 min and 350 mL, respectively. The complication rate was 8.3%. Cancers were pT3-4 in 34.5%. The mean hospital stay and duration of bladder catheterization were 4.3 and 8.2 days, respectively. The rate of positive surgical margins (PSMs) was 17.2% in pT2 cancers. The recovery rate of continence was 98% at 12 months. Intraoperative time, blood loss and length of hospital stay were significantly improved after a short learning curve. The continence recovery, the rate and the length of PSM were also improved beyond the learning curve, but difference was not statistically significant. CONCLUSIONSRALP is a safe and reproducible procedure and offers a short learning curve for experienced laparoscopic surgeons. Beyond the learning curve, continued experience might also provide further improvements in terms of operative, pathological and functional results. KEYWORDSprostate cancer, radical prostatectomy, robotic assistance, learning curve Study Type -Therapy (case series) Level of Evidence 4 OBJECTIVETo describe our current procedure of robotassisted laparoscopic radical prostatectomy (RALP), and to assess the effect of the learning curve on perioperative data, early oncological outcomes and functional results, as RALP has increasingly become a treatment option for men with localized prostate cancer.

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Section: Discussionsupporting

confidence: 79%

Section: Discussionsupporting

confidence: 56%

Robot‐assisted extraperitoneal laparoscopic radical prostatectomy: experience in a high‐volume laparoscopy reference centre

et al. 2010

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“…[5][6][7][8] These findings led to an increasing interest in elucidating the pathophysiology of postoperative erectile dysfunction (ED) and on its potential prophylaxis and treatment. 9 The objective of the current review was to critically evaluate the predictive factors associated with recovery of erectile function after RP.…”

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confidence: 99%

Prediction of sexual function after radical prostatectomy

Briganti

Capitanio

Chun

et al. 2009

Cancer

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Radical prostatectomy (RP) is a commonly used procedure in the treatment of clinically localized prostate cancer. For this report, the authors critically analyzed the factors associated with recovery of erectile function after surgery. A systematic review of the literature using the Medline and CancerLit databases was conducted. Keywords for the literature search included prostate cancer, radical prostatectomy, erectile dysfunction, impotence, treatment, and prophylaxis. Accurate patient selection (based on patient age, preoperative erectile function, and comorbidity profile) and adequate surgical technique (ie, the preservation of neurovascular bundles) were the major determinants of postoperative erectile function. Moreover, better results were achieved when an appropriate pharmacologic treatment using either oral or local approaches was given. Therefore, the authors concluded that, if patients are stratified correctly according to preoperative, intraoperative, and postoperative factors, then a satisfactory functional recovery may be expected after surgery. For these reasons, an ideal multivariate model predicting the restoration of erectile function after surgery should include patient, surgeon, and postsurgical treatment variables. The authors also concluded that the stratification of patients with regard to their risk of developing erectile dysfunction after surgery was feasible based on several parameters, which should be taken into account for correct patient treatment and counseling. To address this objective, accurate tools for predicting the likelihood of complete functional recovery after surgery are needed. Radical prostatectomy (RP) is used increasingly as a therapeutic option for patients who have clinically localized prostate cancer and a life expectancy 10 years. The pioneering work by Walsh and Donker 1 contributed significantly to our understanding of the surgical anatomy of the prostate and represented the basis for the subsequent development of the anatomic RP technique. The objective of this surgical approach is complete excision of the prostate to provide optimal cancer control while maintaining the integrity of the anatomic structures devoted to the functions of urinary continence and sexual potency. [2][3][4] Since the initial reports on this technique, increasing numbers of studies have reported satisfactory *Predictive Modeling in Prostate Cancer, Supplement to Cancer

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“…All the procedures were performed after attending a structured modular training. RALP was performed transperitoneally using the Da Vinci Xi surgical system (Intuitive Surgical, Inc., Sunnyvale, CA, USA) as previously described in details (16). Routine pelvic lymph node dissection (PLND) at time of RALP was performed in presence of high risk PCa and intermediate risk PCa with estimated risk for positive lymph nodes > 5% (2).…”

Section: Methodsmentioning

confidence: 99%

The impact of a structured intensive modular training in the learning curve of robot assisted radical prostatectomy

Schiavina

Borghesi

Dababneh

et al. 2018

Arch Ital Urol Androl

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Aim: The success of Robot Assisted Laparoscopic Prostatectomy (RALP) is mainly due to his relatively short learning curve. Twenty cases are needed to reach a "4 hours-proficiency". However, to achieve optimal functional outcomes such as urinary continence and potency recovery may require more experience. We aim to report the perioperative and early functional outcomes of patients undergoing RALP, after a structured modular training program. Methods: A surgeon with no previous laparoscopic or robotic experience attained a 3 month modular training including: a) e-learning; b) assistance and training to the operating table; c) dry console training; d) step by step in vivo modular training performing 40 surgical steps in increasing difficulty, under the supervision of an experienced mentor. Demographics, intraoperative and postoperative functional outcomes were recorded after his first 120 procedures, considering four groups of 30 cases. Results: All procedures were completed successfully without conversion to open approach. Overall 19 (15%) post operative complications were observed and 84% were graded as minor (Clavien I-II). Overall operative time and console time gradually decreased during the learning curve, with statistical significance in favour of Group 4. The overall continence rate at 1 and 3 months was 74% and 87% respectively with a significant improvement in continence rate throughout the four groups (p = 0.04). Considering those patients submitted to nerve-sparing procedure we found a significant increase in potency recovery over the four groups (p = 0.04) with the higher potency recovery rate up to 80% in the last 30 cases. Conclusions: Optimal perioperative and functional outcomes have been attained since early phase of the learning curve after an intensive structured modular training and less than 100 consecutive procedures seem needed in order to achieve optimal urinary continence and erectile function recovery.KEY WORDS: Training; Robot assisted radical prostatectomy. death in men worldwide (1). Radical prostatectomy (RP) represents the standard surgical treatment for clinically localized prostate cancer (2). Traditionally this procedure was performed with a retropubic open approach retropubic radical prostatectomy (RRP) (3), with the cost of long hospitalization, the need of additional pain medication and significant blood loss. With the aim to reduce morbidity, hospitalization and to improve functional outcomes, minimally invasive approaches including laparoscopic radical prostatectomy (LRP) and robot assisted laparoscopic prostatectomy (RALP) have been increasingly adopted as alternative to open surgery. In the last two decades RALP has gained more popularity and now is a mainstay of treatment for prostate cancer, with functional and oncological outcomes comparable or even better than RRP and LRP (4-6). One of the main reason for the great diffusion of RALP is the short learning curve: contrarily to LRP, where the learning curve is very steep, those surgeons approaching to RALP were able to per...

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Robot-Assisted Laparoscopic Radical Prostatectomy: Oncologic and Functional Results of 184 Cases

Cited by 101 publications

References 21 publications

Robot‐assisted extraperitoneal laparoscopic radical prostatectomy: experience in a high‐volume laparoscopy reference centre

Robot‐assisted extraperitoneal laparoscopic radical prostatectomy: experience in a high‐volume laparoscopy reference centre

Prediction of sexual function after radical prostatectomy

The impact of a structured intensive modular training in the learning curve of robot assisted radical prostatectomy

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