scholarly journals Retropubic, Laparoscopic, and Robot-Assisted Radical Prostatectomy: A Comparative Analysis of the Surgical Outcomes in a Single Regional Center

2017 ◽  
Vol 11 (1) ◽  
pp. 36-41 ◽  
Author(s):  
Lorenzo Giuseppe Luciani ◽  
Daniele Mattevi ◽  
William Mantovani ◽  
Tommaso Cai ◽  
Stefano Chiodini ◽  
...  
Keyword(s):  
Radical Prostatectomy ◽  
Hospital Stay ◽  
Surgical Outcomes ◽  
Complication Rates ◽  
Robot Assisted ◽  
Operative Outcomes ◽  
Regional Center ◽  
Lower Blood ◽  
Continence Rate ◽  
Laparoscopic Assisted

Background: To compare the surgical outcomes of radical prostatectomy (RP) performed via 3 different approaches: retropubic (RRP), laparoscopic-assisted (LRP), and robot-assisted (RARP), in a single non-academic regional center by a single surgeon. Materials and Methods: The data of patients undergoing RP from 2005 to 2014 were reviewed. The standard approach changed through the years: RRP (n = 380, years 2005 to 2008), LRP (n = 240, years 2009 to 2011), and RARP (n = 262, years 2012 to 2014). Our analysis included the last consecutive 100 RP for each surgical technique by a single surgeon. A logistic regression model adjusted for pre-and postoperative variables was done to evaluate whether transfusion, conversion, and post-operative complication rates were influenced by the approach. Results: RARP was associated with significantly lower blood loss (400 vs. 600 and 600 ml, respectively), transfusion (6 vs. 21 and 21%, respectively), and shorter hospital stay (6 vs. 7 and 8 days, respectively), compared to LRP and RRP, and a lower conversion rate (1 vs. 12%) compared to LRP. Multivariate analysis adjusted for confounders confirmed that the risk of transfusion and conversion was significantly lower in the RARP group compared to the LRP and RRP groups. The RARP group was also associated with a significantly lower risk of complications compared to the RRP group and with a trend in favor of the RARP group compared to the LRP group. The 1-year continence rate was significantly higher in the RARP group compared to the RRP and LRP groups (80 vs. 72 and 68%, respectively). Conclusion: The surgical approach affected the operative outcomes in a regional setting. The advantages of RARP over RRP (complications, transfusion, conversion, hospital stay, 1-year continence) were over LRP as well, with the only exception being complications.

Surgeon perception is not a good predictor of peri-operative outcomes in robot-assisted radical prostatectomy

2011 ◽  
Vol 5 (4) ◽  
pp. 283-288 ◽  
Author(s):  
Joshua Stern ◽  
Saurabh Sharma ◽  
Pierre Mendoza ◽  
Mary Walicki ◽  
Rachel Hastings ◽  
...  
Keyword(s):  
Radical Prostatectomy ◽  
Good Predictor ◽  
Robot Assisted ◽  
Operative Outcomes

scholarly journals Switching from Endoscopic Extraperitoneal Radical Prostatectomy to Robot-Assisted Laparoscopic Prostatectomy: Comparing Outcomes and Complications

2015 ◽  
Vol 95 (4) ◽  
pp. 380-385 ◽  
Author(s):  
Robert Wagenhoffer ◽  
Maren Gruner ◽  
Jan Schymik ◽  
Lydia Schachtner ◽  
Liviu Neagoe ◽  
...  
Keyword(s):  
Radical Prostatectomy ◽  
Prostate Volume ◽  
Surgical Techniques ◽  
Surgical Experience ◽  
Robot Assisted ◽  
Laparoscopic Prostatectomy ◽  
Minimally Invasive Surgical ◽  
Lower Blood ◽  
Individual Surgeon ◽  
Pathological Stages

Objective: Endoscopic extraperitoneal radical prostatectomy (EERPE) and robot-assisted laparoscopic prostatectomy (RALP) are minimally invasive surgical techniques to treat localized prostate cancer. We report the outcome and complications of these two techniques conducted by one individual surgeon. Patients and Methods: 86 patients underwent EERPE between January 2008 and June 2011, and 100 patients underwent RALP between August 2011 and October 2012. All surgeries were performed by one single surgeon. Results: The patients of the EERPE and RALP groups had similar clinical characteristics in PSA, prostate volume and D'Amico classification, and were significantly different in their age and BMI as well as in the number of prior surgeries. RALP surgeries were significantly slower (183 vs. 157 min) but also involved lower blood loss (147 vs. 245 ml). Pathological stages and positive surgical margins were similar in both groups. Complications were assessed by the Clavien-Dindo classification. 6 patients in the EERPE group and 3 patients of the RALP group suffered major complications (IIIb-IV). Conclusion: Altogether our results indicate that the learning curve for RALP was short after experience with EERPE. We hypothesize that this is more a result of the surgical experience of the surgeon with the EERPE than on the robotic technique.

937 PERI-OPERATIVE OUTCOMES AND EARLY COMPLICATION RATES AFTER 4000 ROBOT ASSISTED RADICAL PROSTATECTOMIES

2011 ◽  
Vol 185 (4S) ◽  
Author(s):  
Sanket Chauhan ◽  
Rafael Coelho ◽  
Ananthakrishnan Sivaraman ◽  
Kenneth Palmer ◽  
Bernardo Rocco ◽  
...  
Keyword(s):  
Complication Rates ◽  
Early Complication ◽  
Robot Assisted ◽  
Operative Outcomes

Robotic and Laparoscopic Approaches for Adrenal Surgery in Obese Patients

2020 ◽  
pp. 000313482095149
Author(s):  
Hosam Shalaby ◽  
Mohamed Abdelgawad ◽  
Mahmoud Omar, MD ◽  
Ghassan Zora, MD ◽  
Saad Alawwad ◽  
...  
Keyword(s):  
Blood Loss ◽  
Hospital Stay ◽  
Operative Time ◽  
Laparoscopic Approach ◽  
Obese Patients ◽  
Adrenal Surgery ◽  
Robotic Approach ◽  
Robot Assisted ◽  
Operative Outcomes ◽  
Estimated Blood Loss

Objective Minimally invasive adrenalectomy is a challenging procedure in obese patients. Few recent studies have advocated against robot-assisted adrenalectomy, particularly in obese patients. This study aims to compare operative outcomes between the robotic and laparoscopic adrenalectomy, particularly in obese patients. Materials and Methods A retrospective analysis was performed on all consecutive patients undergoing adrenalectomy for benign disease by a single surgeon using either a laparoscopic or robotic approach. Adrenal surgeries for adrenal cancer were excluded. Demographics, operative time, length of hospital stays, estimated blood loss (EBL), and intraoperative and postoperative complications were evaluated. Patients were divided into 2 groups; obese and nonobese. A sub-analysis was performed comparing robotic and laparoscopic approaches in obese and nonobese patients. Results Out of 120, 55 (45.83%) were obese (body mass index ≥ 30 kg/m2). 14 (25.45%) of the obese patients underwent a laparoscopic approach, and 41 (74.55%) underwent a robotic approach. Operative times were longer in the obese vs. nonobese groups (173.30 ± 72.90 minutes and 148.20 ± 61.68 minutes, P = .04) and were associated with less EBL (53.77 ± 82.48 vs. 101.30 ± 122, P = .01). The robotic approach required a longer operative time when compared to the laparoscopic approach (187 ± 72.42 minutes vs. 126.60 ± 54.55 minutes, P = .0102) in the obese but was associated with less blood loss (29.02 ± 51.05 mL vs. 138.30 ± 112.20 mL, P < .01) and shorter hospital stay (1.73 ± 1.23 days vs. 3.17 ± 1.27 days, P < .001). Conclusion Robot-assisted adrenal surgery is safe in obese patients and appears to be longer; however, it provides improvements in postoperative outcomes, including EBL and shorter hospital stay.

Does Continuation of Low-Dose Aspirin During Robot-Assisted Radical Prostatectomy Compromise Surgical Outcomes?

2018 ◽  
Vol 32 (9) ◽  
pp. 852-858 ◽  
Author(s):  
Ashwin Sunil Tamhankar ◽  
Saurabh Ramesh Patil ◽  
Puneet Ahluwalia ◽  
Gagan Gautam
Keyword(s):  
Radical Prostatectomy ◽  
Surgical Outcomes ◽  
Low Dose ◽  
Robot Assisted ◽  
Dose Aspirin ◽  
Low Dose Aspirin

scholarly journals 141 New Guidelines to Reduce Unnecessary Blood Tests, Delayed Discharge and Costs Following Robot Assisted Radical Prostatectomy

2021 ◽  
Vol 108 (Supplement_6) ◽  
Author(s):  
A Nathan ◽  
N Hanna ◽  
A Rashid ◽  
S Patel ◽  
Y Phuah ◽  
...  
Keyword(s):  
Radical Prostatectomy ◽  
Cost Savings ◽  
Clinical Indication ◽  
Validation Dataset ◽  
Complication Rates ◽  
Robot Assisted ◽  
Blood Tests ◽  
Significant Difference ◽  
New Guidelines ◽  
The Impact

Abstract Objectives Routine postoperative blood tests (POBT) following robot assisted radical prostatectomy (RARP) are used to evaluate the impact of surgery on pre-existing co-morbidities and to detect early complications. This practice dates back to an era of open surgery, when blood loss and complication rates were higher. We propose new guidelines to improve the specificity of POBT. Method The cases of 1040 consecutive patients who underwent a primary or salvage RARP at two large tertiary urology centres in the United Kingdom were retrospectively reviewed to form new guidelines. The new guidelines were prospectively validated in a sample of 300 patients. Results Derivation Dataset: 3% and 5% had intra- and post-operative Clavien-Dindo complications, respectively. 15% had clinical concerns postoperatively. 0.9% required perioperative transfusion. 78% had routine blood tests without clinical concerns, none of whom developed a complication. 98% of complications were suspected by clinical judgement. 6% of patients had a discharge delay of ≥ 1 day due to delayed or incomplete blood tests. Validation Dataset: No significant difference existed in complication, clinical concern or transfusion rates between the derivation and validation datasets. Number of POBT requested reduced by 73% (p &lt; 0.001). The new guidelines improved POBT sensitivity for complications from 98% to 100% and specificity from 0% to 74%. Discharge delays reduced from 6% to 0% (p = 0.008). Cost savings were £178 per patient. Conclusions Postoperative complications and transfusion following RARP are rare. Routine POBT without clinical indication are unnecessary and inefficient. A guideline-based approach to POBT can reduce costs and optimise discharge without compromising patient safety or care.

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