Robotic Prostatectomy: A Review of Outcomes Compared with Laparoscopic and Open Approaches

Berryhill, Roy; Jhaveri, Jay; Yadav, Rajiv; Leung, Robert; Rao, Sandhya; El-Hakim, Assaad; Tewari, Ashutosh

doi:10.1016/j.urology.2007.12.038

Cited by 175 publications

(104 citation statements)

References 60 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Additional hand searches based on references from relevant review articles were also performed. [13][14][15] Only studies that were published in the English language and with a sample size of 250 or more patients were considered. Studies with a total sample size larger than 250 patients but with fewer patients specifically evaluated for continence or potency rates were also included in the analysis.…”

Section: Methodsmentioning

confidence: 99%

Retropubic, Laparoscopic, and Robot-Assisted Radical Prostatectomy: A Critical Review of Outcomes Reported by High-Volume Centers

Coelho

Rocco

Patel

et al. 2010

Journal of Endourology

243

149

View full text Add to dashboard Cite

Purpose: To critically review perioperative outcomes, positive surgical margin (PSM) rates, and functional outcomes of several large series of retropubic radical prostatectomy (RRP), laparoscopic RP (LRP), and robotassisted radical prostatectomy (RARP) currently available in the literature. Methods: A Medline database search was performed from November 1994 to May 2009, using medical subject heading search terms ''prostatectomy'' and ''Outcome Assessment (Health Care)'' and text words ''retropubic,'' ''robotic,'' and ''laparoscopic.'' Only studies with a sample size of 250 or more patients were considered. Weighted means were calculated for all outcomes using the number of patients included in each study as the weighing factor. Results: We identified 30 articles for RRP, 14 for LRP, and 14 for RARP. The mean intraoperative and postoperative RRP transfusion rates for RRP, LRP, and RARP were 20.1%, 3.5%, and 1.4%, respectively. The weighted mean postoperative complication rates for RRP, LRP, and RARP were 10.3% (4.8% to 26.9%), 10.98% (8.9 to 27.7%), and 10.3% (4.3% to 15.7%), respectively. RARP revealed a mean overall PSM rate of 13.6%, whereas LRP and RRP yielded a PSM of 21.3% and 24%, respectively. The weighted mean continence rates at 12 month follow-up for RRP, LRP, and RARP were 79%, 84.8%, and 92%, respectively. The weighted mean potency rates for patients who underwent unilateral or bilateral nerve sparing, at 12 month follow-up, were 43.1% and 60.6% for RRP, 31.1% and 54% for LRP, and 59.9% and 93.5% for RARP. Conclusion: RRP, LRP, and RARP performed in high-volume centers are safe options for treatment of patients with localized prostate cancer, presenting similar overall complication rates. LRP and RARP, however, are associated with decreased operative blood loss and decreased risk of transfusion when compared with RRP. Our analysis including high-volume centers also showed lower weighted mean PSM rates and higher continence and potency rates after RARP compared with RRP and LRP. However, the lack of randomized trials precludes definitive conclusions.

show abstract

Section: Methodsmentioning

confidence: 99%

Retropubic, Laparoscopic, and Robot-Assisted Radical Prostatectomy: A Critical Review of Outcomes Reported by High-Volume Centers

Coelho

Rocco

Patel

et al. 2010

Journal of Endourology

243

149

View full text Add to dashboard Cite

show abstract

“…4 These features refine the surgeon's dexterity, especially when working in a narrow space like the male pelvis during radical prostatectomy, all with the benefits of pneumoperitoneum to reduce blood loss.…”

Section: Introductionmentioning

confidence: 99%

Oncological and functional outcomes of 722 robot-assisted radical prostatectomy (RARP) cases: The largest Canadian 5-year experience

Tholomier

Bienz²,

Hueber³

et al. 2014

CUAJ

Self Cite

View full text Add to dashboard Cite

Introduction: While RARP (robotic-assisted radical prostatectomy) has become the predominant surgical approach to treat localized prostate cancer, there is little Canadian data on its oncological and functional outcomes. We describe the largest RARP experience in Canada. Methods: Data from 722 patients who underwent RARP performed by 7 surgeons (AEH performed 288, TH 69, JBL 23, SB 17, HW 15, QT 7, and KCZ 303 patients) were collected prospectively from October 2006 to December 2013. Preoperative characteristics, as well as postoperative surgical and pathological outcomes, were collected. Functional and oncological outcomes were also assessed up to 72 months postoperative. Results: The median follow-up (Q1-Q3) was 18 months (9-36). The D'Amico risk stratification distribution was 31% low, 58% intermediate and 11% high-risk. The median operative time was 178 minutes (142-205), blood loss was 200 mL (150-300) and the postoperative hospital stay was 1 day (1-23). The transfusion rate was only 1.0%. There were 0.7% major (Clavien III-IV) and 10.1% minor (Clavien I-II) postoperative complications, with no mortality. Pathologically, 445 men (70%) were stage pT2, of which 81 (18%) had a positive surgical margin (PSM). In addition, 189 patients (30%) were stage pT3 and 87 (46%) with PSM. Urinary continence (0-pads/day) returned at 3, 6, and 12 months for 68%, 80%, and 90% of patients, respectively. Overall, the potency rates (successful penetration) for all men at 6, 12, and 24 months were 37%, 52%, and 59%, respectively. Biochemical recurrence was observed in 28 patients (4.9%), and 14 patients (2.4%) were referred for early salvage radiotherapy. In total, 49 patients (8.4%) underwent radiotherapy and/or hormonal therapy. Conclusions: This study shows similar results compared to other high-volume RARP programs. Being the largest RARP experience in Canada, we report that RARP is safe with acceptable oncologic outcomes in a Canadian setting. IntroductionProstate cancer is the most frequently diagnosed cancer in Canadian men, with an incidence of 104 cases/100 000 per year, and with an estimated 23 600 newly cases diagnosed in 2013. 1 In the United States, robotic-assisted radical prostatectomy (RARP) has gained increasing importance in the surgical management of prostate cancer since its first implementation in 2001.2 In 2009, 61% of these procedures were robotically assisted and in 2013, 69% to 85% of prostatectomies were performed robotically, and a minority by radical retropubic prostatectomy (RRP), perineal prostatectomy (PR) or laparoscopic radical prostatectomy (LRP). 3In Canada, however, the shift in prostatectomy practice and the growing interest for RARP is more recent, with only 20 active daVinci systems in 2013.Robotic surgery provides certain inherent advantages, including high definition 3-D vision, magnification, tremor filtration, movement scaling, and wristed instrumentation with 6-degrees of freedom.4 These features refine the surgeon's dexterity, especially when working in a narrow space like t...

show abstract

“…Berryhill et al [5] published an extensive review comparing RARP with LRP and open surgery and reported weighted mean positive margin rates of 12.5%, 19.6% and 23.5% for RARP, LRP and RRP, respectively. This study was limited by selection bias and may not reflect lower positive margin rates usually achieved by experienced surgeons.…”

Section: Discussionmentioning

confidence: 99%

“…The evolution of surgical technique from pure laparoscopic to robotic prostatectomy has been attributed in part to the steep learning curve associated with laparoscopic radical prostatectomy (LRP). Robotic-assisted surgical techniques incorporate features such as three-dimensional viewing, improved ergonomics, hand tremor elimination and refined dexterity [5].…”

Section: Introductionmentioning

confidence: 99%

1003 Impact of Surgical Technique (Open vs. Laparoscopic vs. Robotic-Assisted) on Pathological and Biochemical Outcomes Following Radical Prostatectomy: An Analysis Using Propensity Score Matching

Magheli¹,

Gonzalgo²,

Su³

et al. 2011

European Urology Supplements

View full text Add to dashboard Cite

Robotic Prostatectomy: A Review of Outcomes Compared with Laparoscopic and Open Approaches

Cited by 175 publications

References 60 publications

Retropubic, Laparoscopic, and Robot-Assisted Radical Prostatectomy: A Critical Review of Outcomes Reported by High-Volume Centers

Retropubic, Laparoscopic, and Robot-Assisted Radical Prostatectomy: A Critical Review of Outcomes Reported by High-Volume Centers

Oncological and functional outcomes of 722 robot-assisted radical prostatectomy (RARP) cases: The largest Canadian 5-year experience

1003 Impact of Surgical Technique (Open vs. Laparoscopic vs. Robotic-Assisted) on Pathological and Biochemical Outcomes Following Radical Prostatectomy: An Analysis Using Propensity Score Matching

Contact Info

Product

Resources

About