Robotic-Assisted Laparoscopic Radical Prostatectomy: Perioperative Outcomes Of 1500 Cases

Main Category: Prostate / Prostate Cancer
Also Included In: Urology / Nephrology
Article Date: 15 Nov 2008 - 1:00 PDT

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UroToday.com - Consistent with a previous series of robotic-assisted laparoscopic radical prostatectomies (RALP) in over 2,500 patients, reported by Menon, et al., Dr. Vipul Patel presented his group's data on 1,500 RALP patients and confirmed the high-quality outcomes of this procedure. In the online version of the Journal of Endourology, Dr. Patel reported on 1,500 men on whom he performed transperitoneal RALP.

The 6-port procedure began with ligation of the dorsal venous complex followed by bladder neck dissection and mobilization of the seminal vesicles. The cavernous nerves were released early in the operation - beginning at the prostatic apex and back to the base. The ligation of the pedicles was then accomplished. After removal of the prostate, the urethral anastomosis was performed using a double-armed 3-0 monocryl suture beginning posteriorly and continuing anteriorly on both sides. Patients underwent early return of diet and ambulation. Catheters were removed between days 4 and 7 following cystogram that demonstrated no anastomotic leak. Prospective data was collected including peri-operative variables, the EPIC questionnaire, SHIM scores, AUA symptom scores, pathology, OR time, EBL and length of hospital stay.

Mean OR time was 105 minutes, and mean EBL was 111cc. No patients received intraoperative blood transfusions and the post-operative transfusion rate was 0.4%. Remarkably, no patients required conversion to an open prostatectomy. In the first 25 cases there were 2 rectal injuries that were repaired primarily. The mean post-operative hematocrit change was 3.1 points with an average discharge hematocrit of 36%. Discharge to home occurred on post-operative day #1 in 97% of patients. Mean catheter time was 6.3 days and complications occurred in 63 patients (4.3%). The distribution of the most common complications were: hemorrhage in 8 patients, 22 anastomic leaks requiring longer catheter time, 5 episodes of urinary retention, 4 myocardial infarctions, 4 wound infections, 3 pulmonary embolisms, 3 incisional hernias, and 2 cases of deep venous thrombosis. Mean Gleason score was 6 and pathologic stage was T2a, T2b, T2c, T3a, T3b, and T4 in 15%, 3%, 60%, 14%, 6%, and 1%, respectively. Mean prostate volume was 50g. The positive surgical margin rate was 4% for pT2, 34% for pT3 and 40% for pT4. Distribution based on prostate volumes of <50gm, 50-99gm, and >100gm revealed positive margin rates of 14.3%, 9.4%, and 5.9%, respectively.

These outcomes support the oncologic and peri-operative outcomes of RALP. Unfortunately, continence and potency outcomes are not reported in this article.

Patel VR, Palmer KJ, Coughlin G, Samavedi S
J Endourol. 2008 Oct;22(10):2299-305
doi:10.1089/end.2008.9711

Written by UroToday.com Contributing Editor Christopher P. Evans, MD, FACS

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