Robot-assisted versus open radical prostatectomy: a comparison of one surgeon's outcomes

Ahlering, Thomas E.; Woo, David H.; Eichel, Louis; Lee, David I.; Edwards, Robert A.; Skarecky, Douglas

doi:10.1016/j.urology.2004.01.038

Cited by 284 publications

(248 citation statements)

References 12 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: 91%

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: 91%

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

et al. 2010

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“…In a more recent comparison from the same institution, Kordan et al reported a median EBL of 450 ml in the ORP group compared to 100 ml in the RALP group ( p < 0.001)[24]. Multiple other single-institution series have shown lower EBL in patients treated with RALP than in those treated with ORP[19,21,25,26,27,28]. To our knowledge, no study has demonstrated lower EBL in patients treated with ORP compared to RALP.…”

Section: Comparison and Discussion Of Orp And Ralpmentioning

confidence: 99%

“…The mean time to continence recovery for RALP patients was 25 days compared with 75 days for ORP patients ( p < 0.001). In a single-surgeon study by Ahlering et al, which used an unvalidated questionnaire and defined complete continence as requiring no pads, the authors reported similar continence rates for RALP and ORP (75 vs. 76%)[25]. Using a telephone interview with 120 patients (a subset of the original 300 patients in their study), Tewari et al also showed that RALP patients had a faster return of urinary continence[21].…”

Section: Comparison and Discussion Of Orp And Ralpmentioning

confidence: 99%

Evidence-Based Comparison of Robotic and Open Radical Prostatectomy

Lowrance

Tarin

Shariat

2010

The Scientific World JOURNAL

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The rapid adoption of robotic-assisted laparoscopic radical prostatectomy (RALP) has occurred despite a lack of high-quality evidence demonstrating its oncologic advantages, safety, or cost effectiveness compared with open radical retropubic prostatectomy (ORP). This review examines the current literature comparing ORP and RALP, focusing on perioperative, oncologic, functional, and economic outcomes.

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“…Robotic surgery is now being presented as a new tool that enhances safety, allows remote operation, and enables operations to be performed in a limited space 4. When compared to laparoscopic surgery, robotic surgery was found to be equivalent in selected urologic, gynecologic, and visceral operations 5, 6, 7, 8. Initial attempts to use robotic assistance in kidney transplantation were successful.…”

Section: Introductionmentioning

confidence: 99%

Intra-Abdominal Cooling System Limits Ischemia–Reperfusion Injury During Robot-Assisted Renal Transplantation

Meier

Piller

Hagen

et al. 2018

American Journal of Transplantation

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Robot‐assisted kidney transplantation is feasible; however, concerns have been raised about possible increases in warm ischemia times. We describe a novel intra‐abdominal cooling system to continuously cool the kidney during the procedure. Porcine kidneys were procured by standard open technique. Groups were as follows: Robotic renal transplantation with (n = 11) and without (n = 6) continuous intra‐abdominal cooling and conventional open technique with intermittent 4°C saline cooling (n = 6). Renal cortex temperature, magnetic resonance imaging, and histology were analyzed. Robotic renal transplantation required a longer anastomosis time, either with or without the cooling system, compared to the open approach (70.4 ± 17.7 min and 74.0 ± 21.5 min vs. 48.7 ± 11.2 min, p‐values < 0.05). The temperature was lower in the robotic group with cooling system compared to the open approach group (6.5 ± 3.1°C vs. 22.5 ± 6.5°C; p = 0.001) or compared to the robotic group without the cooling system (28.7 ± 3.3°C; p < 0.001). Magnetic resonance imaging parenchymal heterogeneities and histologic ischemia–reperfusion lesions were more severe in the robotic group without cooling than in the cooled (open and robotic) groups. Robot‐assisted kidney transplantation prolongs the warm ischemia time of the donor kidney. We developed a novel intra‐abdominal cooling system that suppresses the noncontrolled rewarming of donor kidneys during the transplant procedure and prevents ischemia–reperfusion injuries.

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Robot-assisted versus open radical prostatectomy: a comparison of one surgeon's outcomes

Cited by 284 publications

References 12 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

Evidence-Based Comparison of Robotic and Open Radical Prostatectomy

Intra-Abdominal Cooling System Limits Ischemia–Reperfusion Injury During Robot-Assisted Renal Transplantation

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