Examining and Understanding Value: The Impact of Preoperative Characteristics, Intraoperative Variables, and Postoperative Complications on Cost of Robot-Assisted Laparoscopic Radical Prostatectomy

2019 ◽  
Vol 33 (7) ◽  
pp. 541-548 ◽  
Author(s):  
Leslie Peard ◽  
Jeffrey Goodwin ◽  
Patrick Hensley ◽  
Adam Dugan ◽  
Jason Bylund ◽  
...  
Keyword(s):  
Postoperative Complications ◽  
Radical Prostatectomy ◽  
Laparoscopic Radical Prostatectomy ◽  
Robot Assisted ◽  
The Impact

Postoperative complications of contemporary open and robot-assisted laparoscopic radical prostatectomy using standardised reporting systems

2018 ◽  
Vol 122 (5) ◽  
pp. 801-807 ◽  
Author(s):  
Raisa S. Pompe ◽  
Burkhard Beyer ◽  
Alexander Haese ◽  
Felix Preisser ◽  
Uwe Michl ◽  
...  
Keyword(s):  
Postoperative Complications ◽  
Radical Prostatectomy ◽  
Laparoscopic Radical Prostatectomy ◽  
Robot Assisted ◽  
Reporting Systems

scholarly journals Positive surgical margin rates during the robot-assisted laparoscopic radical prostatectomy learning curve of an experienced laparoscopic surgeon

2017 ◽  
Vol 11 (11) ◽  
pp. E409-13 ◽  
Author(s):  
Anthony F. Adili ◽  
Julia Di Giovanni ◽  
Emma Kolesar ◽  
Nathan C. Wong ◽  
Jen Hoogenes ◽  
...  
Keyword(s):  
Radical Prostatectomy ◽  
Learning Curve ◽  
Surgical Margin ◽  
Margin Status ◽  
Laparoscopic Radical Prostatectomy ◽  
Positive Surgical Margin ◽  
Robot Assisted ◽  
Estimated Blood Loss ◽  
The Mean ◽  
The Impact

Introduction: Since its introduction, robot-assisted laparoscopic radical prostatectomy (RARP) has gained widespread popularity, but is associated with a variable learning curve. Herein, we report the positive surgical margin (PSM) rates during the RARP learning curve of a single surgeon with significant previous laparoscopic radical prostatectomy (LRP) experience.Methods: We performed a prospective cohort study of the first 400 men with prostate cancer treated with RARP by a single surgeon (BS) with significant LRP experience. Our primary outcome was the impact of case timing in the learning curve on margin status. Our analysis was conducted by dividing the case numbers into quartiles (Q1‒Q4) and determining if a case falling into an earlier quartile had an impact on margin status relative to the most recent quartile (Q4).Results: The Q1 cases had an odds ratio for margin positivity of 1.74 compared to Q4 (p=0.1). Multivariate logistic regression did not demonstrate case number to be a significant predictor of PSM. The mean Q1 operative time was 207.4 minutes, decreasing to 179.2 by Q4 (p<0.0001). The mean Q1 estimated blood loss was 255.1 ml, decreasing to 213.6 by Q4 (p=0.0064). There was no change in length of hospitalization within the study period.Conclusions: Even when controlling for copredictors, a statistically significant learning curve for PSM rate of a surgeon with significant previous LRP experience was not detected during the first 400 RARP cases. We hypothesize that previous LRP experience may reduce the RARP PSM learning curve.

The Impact of Prostate Gland Weight in Robot Assisted Laparoscopic Radical Prostatectomy

2008 ◽  
Vol 180 (3) ◽  
pp. 928-932 ◽  
Author(s):  
Brian A. Link ◽  
Rebecca Nelson ◽  
David Y. Josephson ◽  
Jeffrey S. Yoshida ◽  
Laura E. Crocitto ◽  
...  
Keyword(s):  
Radical Prostatectomy ◽  
Prostate Gland ◽  
Laparoscopic Radical Prostatectomy ◽  
Robot Assisted ◽  
Gland Weight ◽  
The Impact

scholarly journals A meta-analysis of robot assisted laparoscopic radical prostatectomy versus laparoscopic radical prostatectomy

Open Medicine ◽  
2019 ◽  
Vol 14 (1) ◽  
pp. 485-490 ◽  
Author(s):  
Tao Wang ◽  
Qunsuo Wang ◽  
Songtao Wang
Keyword(s):  
Prostate Cancer ◽  
Postoperative Complications ◽  
Radical Prostatectomy ◽  
Meta Analysis ◽  
Surgical Margin ◽  
Laparoscopic Radical Prostatectomy ◽  
Localized Prostate Cancer ◽  
Urinary Continence ◽  
Robot Assisted ◽  
Continence Rate

AbstractObjectiveTo evaluate the efficacy and safety of robot-assisted laparoscopic radical prostatectomy (RALP) and laparoscopic radical prostatectomy (LRP) for the treatment of localized prostate cancer.MethodsMeta-analysis was applied using Review Manager V5.3 software and the retrieved clinical trials comparing RALP with LRP for the treatment of localized prostate cancer published from 2000 to 2018 in PubMed, Ovid, ScienceDirect, and EMBASE datasets were analyzed.ResultsThis meta-analysis included 16 articles, totaling 7952 patients, with 5170 RALP patients and 2782 LRP patients. Meta-analysis showed that RALP postoperative complications were fewer (P=0.0007), and the postoperative urinary continence rate was better at 1 year after surgery (P<0.00001). There was no statistical significance between RALP and LRP with regards to the positive incidence of surgical margin (P = 0.18).ConclusionAs an emerging technology, RALP is superior to LRP for localized prostate cancer treatment in terms of postoperative complications, and postoperative urinary continence rate.

scholarly journals Urinary Continence after Robot-Assisted Laparoscopic Radical Prostatectomy: The Impact of Intravesical Prostatic Protrusion

2016 ◽  
Vol 57 (5) ◽  
pp. 1145 ◽  
Author(s):  
Jung Ki Jo ◽  
Sung Kyu Hong ◽  
Seok-Soo Byun ◽  
Homayoun Zargar ◽  
Riccardo Autorino ◽  
...  
Keyword(s):  
Radical Prostatectomy ◽  
Laparoscopic Radical Prostatectomy ◽  
Urinary Continence ◽  
Robot Assisted ◽  
The Impact ◽  
Intravesical Prostatic Protrusion

scholarly journals Morbid obesity is adversely associated with perioperative outcomes in patients undergoing robot-assisted laparoscopic radical prostatectomy

2020 ◽  
Vol 14 (11) ◽  
Author(s):  
Hedong Han ◽  
Yingyi Qin ◽  
Yiming Ruan ◽  
Jia He ◽  
Zhexu Cao ◽  
...  
Keyword(s):  
Morbid Obesity ◽  
Postoperative Complications ◽  
Radical Prostatectomy ◽  
Propensity Score ◽  
Laparoscopic Radical Prostatectomy ◽  
Class I ◽  
Perioperative Outcomes ◽  
Robot Assisted ◽  
Obesity Class ◽  
Propensity Score Weighting

Introduction: Robot-assisted laparoscopic radical prostatectomy (RALRP) may be more challenging in obese individuals. This study aimed to evaluate whether obesity had an adverse effect on perioperative outcomes following RALRP. Methods: Hospitalized patients who underwent RALRP from 2008–2014 were identified using the National Inpatient Sample database. We grouped RALRP patients into non-obese, obesity class I–II and obesity class III (morbid obesity). Rates of blood transfusion, intraoperative and postoperative complications, in-hospital mortality, prolonged length of stay, and total costs were compared among the three groups by univariate regression, multivariate regression, and propensity score weighting analysis. Results: Of 53 301 patients identified, 48 725 were non-obese, 3572 were diagnosed with obesity class I–II, and 1004 were diagnosed with morbid obesity. Compared to non-obesity (7.62%), overall postoperative complications were commonly observed in obesity class I–II (10.55%) and morbid obesity (17.11%). Multivariable analyses suggested that morbid obesity was associated with increased overall postoperative (odds ratio [OR] 2.00; 95% confidence interval [CI] 1.65–2.42), cardiac (OR 1.63; 95% CI 1.03–2.58), respiratory (OR 4.03; 95% CI 3.04–5.36), genitourinary (OR 1.77; 95% CI 1.08–2.90), miscellaneous medical (OR 1.94; 95% CI 1.58–2.39) complications, prolonged hospitalization (OR 1.86; 95% CI 1.57–2.21), and 12% higher total cost. Propensity score weighting analysis yielded similar results. Adequate covariate balance was achieved for all variables after weighting. Conclusions: Morbid obesity is adversely associated with perioperative outcomes in RALRP. Close management is required in patients undergoing RALRP with morbid obesity for potential worse prognosis.

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