Robot-assisted simple prostatectomy versus open simple prostatectomy: a single-center comparison

Abstract

Purpose Open simple prostatectomy (OSP) is a standard surgical technique for patients with benign prostatic hyperplasia with prostate size larger than 80 ml. As a minimally invasive approach, robot-assisted simple prostatectomy (RASP) emerged as a feasible surgical alternative. Currently, there are no definite recommendations for the standard use of RASP. Therefore, we aimed at investigating various clinical outcomes comparing RASP with OSP. Methods In this retrospective single-center study, we evaluated clinical data from 103 RASP and 31 OSP patients. Both cohorts were compared regarding different clinical characteristics with and without propensity score matching. To detect independent predictive factors for clinical outcomes, multivariate logistic regression analysis was performed. Results Robot-assisted simple prostatectomy patients demonstrated a lower estimated blood loss and need for postoperative blood transfusions as well as less postoperative complications. OSP had a shorter operative time (125 min vs. 182 min) longer hospital stay (11 days vs. 9 days) and longer time to catheter removal (8 days vs. 6 days). In the multivariate analysis, RASP was identified as an independent predictor for longer operative time, lower estimated blood loss, shorter length of hospital stay, shorter time to catheter removal, less postoperative complications and blood transfusions. Conclusion Robot-assisted simple prostatectomy is a safe alternative to OSP with less perioperative and postoperative morbidity. Whether OSP (shorter operative time) or RASP (shorter length of hospital stay) has a more favorable economic impact depends on the particular conditions of different health care systems. Further prospective comparative research is warranted to define the value of RASP in the current surgical management of benign prostatic hyperplasia.

Robotic-Assisted vs. Open Simple Prostatectomy for Large Prostates: A Meta-Analysis

“…LOS data were reported in six studies involving 3,699 patients ( Figure 2B ) ( 5 , 10 , 12 – 15 ), of whom 936 underwent RASP and 2,763 underwent OSP. Patients treated with RASP had a shorter LOS.…”

“…Data on EBL were obtained from five studies ( 5 , 10 – 13 ) including 444 patients (232 in the RASP group and 212 in the OSP group) ( Figure 3A ). The pooled outcome indicated that EBL was lower in the RASP group than in the OSP group (WMD, −304.68; 95% CI, −432.91, −176.44; P < 0.001; I 2 = 86%).…”

“…Current guidelines recommend OSP as the standard treatment for large prostate glands (≥80 g) (16,17). Although OSP can significantly improve LUTS in patients with BPH, it is also associated with longer LOS, longer CT, and higher EBL than RASP, as well as a higher rate of complications (5,(10)(11)(12)(13).…”

“…One hundred and seventy-eight records were removed after review of the full text. Finally, the remaining seven studies with 3,777 patients (975 in the RASP groups and in the 2,802 group) were included in our meta-analysis (Figure 1) (5,(10)(11)(12)(13)(14)(15). The quality evaluation of the included studies is presented in Table 1.…”

“…Open simple prostatectomy (OSP) has been the standard surgical treatment for men with moderate to severe LUTS and a prostate size larger than 80 mL ( 3 ). However, OSP has significant side effects, like bleeding, requirement for blood transfusion, and revision surgery ( 5 ). With the development of minimally invasive surgery, laser enucleation and laparoscopic surgery are being more commonly performed in the clinic ( 6 , 7 ).…”