Robot‐assisted simple prostatectomy (RASP): does it make sense?

Abstract

What ' s known on the subject? and What does the study add?The open simple prostatectomy (OSP) is the ' gold standard ' for high-volume prostate adenomas. It shows very good functional results despite its invasiveness. Minimally invasive approaches, e.g. laparoscopy or holmium laser enucleation of the prostate, have been ' tested ' but none have proved a substitute for the OSP.The robot-assisted approach provides optimal functional results and is easy to perform for experienced robotic surgeons. Extending the indication of robotics to low-incidence pathologies can take advantage of the opportunity to ' see the procedure ' using available information technology, e.g. Youtube TM that presents as an unexpectedly useful tool. OBJECTIVE• To evaluate the outcome, feasibility and reproducibility of a robot-assisted (RA) approach for simple prostatectomy (SP) in cases of high-volume symptomatic benign prostatic hyperplasia (HVS-BPH). PATIENTS AND METHODS• In all, 35 consecutive patients underwent RASP for HVS-BPH using a previously described technique.• The mean prostate volume on preoperative transrectal ultrasonography was 106.6 mL.• All but two patients (with bladder calculi) had an adenoma volume of > 65 mL and 27 (77.1%) > 80 mL. Nine patients (25.7%) had an indwelling catheter.• The mean International Prostate Symptom Score (IPSS) was 28. RESULTS• The median operative duration was 180 min and the mean hospital stay was 3.17 days.• The mean catheter duration was 7.4 days and discontinuous or continuous catheter irrigation was required in two and seven patients, respectively (25.1%).• In all, 10 patients (28.6%) had practically no blood loss. No patients had a transfusion.• The mean postoperative peak urinary fl ow was 18.9 mL/s ( P < 0.001), while the mean IPSS was 7 ( P < 0.001).• For costs, while superfi cially RASP appeared more expensive than open SP (OSP), when considering the higher costs of hospitalisation for OSP, RASP was cheaper. Also, bipolar-TURP costs in patients with large-volume prostates had rather similar costs to RASP. CONCLUSIONS• RASP is a feasible and reproducible procedure with outcome advantages when compared with the open or with other minimally invasive techniques (laser or laparoscopy). As a result, a RA approach is worth considering in cases of high-volume prostate adenomas.• Extending the indication of the RA approach, to the SP, requires fi rstly that the surgeon be profi cient in RA surgery and secondly that as the incidence rate of HVS-BPH is low, the surgeon has had the opportunity to ' see the procedure ' . calculi, diverticula, etc.) were present. In fact, for these patients, OSP seems to be more effective and safer than TURP [ 7 ] .Nevertheless, looking at historical and more recent series [ 1 -7 ] one notices that, while

Initial Canadian experience with robotic simple prostatectomy: Case series and literature review

“…5 These values are comparable to our OSP mean length of operation time of 79 minutes and a mean length of stay of 5.5 days, though our transfusion rate is higher at 46.4%.…”

“…Though beyond the scope of this study, this is an important factor, especially in the cost-conscious Canadian healthcare system. Matei and colleagues 5 addressed this issue and determined that although the instrument costs robotic simple prostatectomy and operating costs, secondary to longer operating times, of RASP exceeded OSP, RASP was ultimately more costeffective (by about $850 CAD per patient). 5 Savings were mainly secondary to a decreased length of hospitalization.…”

“…Matei and colleagues 5 addressed this issue and determined that although the instrument costs robotic simple prostatectomy and operating costs, secondary to longer operating times, of RASP exceeded OSP, RASP was ultimately more costeffective (by about $850 CAD per patient). 5 Savings were mainly secondary to a decreased length of hospitalization. The social impact of robotic surgery, including patients returning to work sooner, has yet to be quantified and could further support the cost-effective argument of RASP.…”

Robot-assisted simple prostatectomy with temporary internal iliac arteries clamping: our preliminary results

“…The operative times, the hospitalization, the low dose of analgesics required and the minimal blood loss calculated, were similar to those seen in laparoscopic series. [7,15,[17][18][19] Matei et al [20] have recently reported the series of 35 patients underwent RASP. Although Matei and colleagues presented the largest series of RASP, we reported our series of 18 patients treated with RASP and early vascular control: the temporarily bilateral internal iliac arteries clamping.…”

“…[21] Our results showed a median estimated blood loss (EBL) of 200 mL that is less than the median value of the other series (> 300 mL). [20] No transfusions have been necessary. Despite the vascular control, our median operating time is superimposable to the RASP performed without clamping the iliac arteries.…”