Challacombe, B. and P. Dasgupta (2012). “Reply to Alchiede Simonato and Marco Ennas’ Letter to the Editor re: Ben J. Challacombe, Bernard H. Bochner, Prokar Dasgupta, et al. the role of laparoscopic and robotic cystectomy in the management of muscle-invasive bladder cancer with special emphasis on cancer control and complications. Eur Urol 2011;60:767-75.” European Urology 61(4).
Guillotreau, J., R. Miocinovic, et al. (2012). “Outcomes of laparoscopic and robotic radical cystectomy in the elderly patients.” Urology 79(3): 585-590.
OBJECTIVE: To compare the perioperative outcomes of laparoscopic/robotic radical cystectomy (LRRC) for urothelial cancer of bladder (UCB) between elderly (>/=70 years) and younger (<70 years) patients. MATERIALS AND METHODS: A retrospective review of 146 patients who underwent LRRC between 2003 and 2010 at 2 academic institutions (Cleveland, Ohio, United States and Toulouse, France) was performed. Of these, 74 patients were classified as elderly (>/=70 years) and 72 patients were considered younger (<70 years). Perioperative outcomes, final pathology results, overall survival (OS), and cancer specific survival (CSS) were compared between the 2 groups. RESULTS: Both groups had similar clinical stage at diagnosis, American Society of Anesthesiologists score, body mass index, and gender distribution. Ileal conduit-type diversion was favored in the older vs younger group, 84% vs 36%, respectively. Overall conversion rate to open procedures was 4% in both groups. Perioperative complication rate was not significantly different between the younger and older patients. Positive margin rate was 5% in both groups. The 5-year OS for older and younger patients was 75% and 87%, respectively (P = .03), and the 5-year CSS for the 2 groups was 51% and 54%, respectively (P = .7). CONCLUSION: Laparoscopic/robotic radical cystectomy in the elderly does not have worse perioperative complications or pathologic outcomes compared with younger patients and therefore can be offered as treatment option in select older patients.
Seyam, R., H. M. Alzahrani, et al. (2012). “Robotic partial cystectomy for lymphangioma of the urinary bladder in an adult woman.” Journal of the Canadian Urological Association 6(1): E8-E10.
Lymphangioma of the urinary bladder is a very rare tumour in adulthood. Robotic partial cystectomy is evolving for treatment of a limited number of bladder tumours. We describe a case of an adult woman with a bladder dome lymphangioma for which robotic partial cystectomy was carried out. © 2012 Canadian Urological Association.
Simonato, A. and M. Ennas (2012). “Re: Ben J. Challacombe, Bernard H. Bochner, Prokar Dasgupta, et al. the role of laparoscopic and robotic cystectomy in the management of muscle-invasive bladder cancer with special emphasis on cancer control and complications. Eur Urol 2011;60:767-75.” European Urology 61(4).
Torrey, R. R., K. G. Chan, et al. (2012). “Functional Outcomes and Complications in Patients With Bladder Cancer Undergoing Robotic-assisted Radical Cystectomy With Extracorporeal Indiana Pouch Continent Cutaneous Urinary Diversion.” Urology.
Objective: To evaluate the functional outcomes and complications for patients with bladder cancer undergoing robotic-assisted laparoscopic radical cystectomy with Indiana pouch continent cutaneous urinary diversion. Methods: From February 2004 to March 2010, 34 patients underwent robotic-assisted laparoscopic radical cystectomy with Indiana pouch continent cutaneous urinary diversion reconstruction. After surgery, the complications were identified, categorized, and graded using an established 5-grade modification of the original Clavien grading system, and continence was assessed. Descriptive statistics were used in evaluating the outcomes. Fischer’s exact test was used in the comparison of early and late Clavien grade III complications. Results: Overall, 175 (123 early and 52 late) complications after surgery were reported in 32 (94%) of 34 patients. Within 90 days of surgery, 31 (91%) of 34 patients experienced ≥1 early complication. Of 34 patients, 15 (44%) reported ≥1 late complications (>90 days). Most (85% and 69%, respectively) early and late complications were graded as minor (grade II or less). Fewer patients with early complications required an additional intervention (grade III) compared with patients with late complications (14% vs 31%; P = .116). The most common complication in both intervals was infection, reported in 22% and 37% of patients with early and late complications, respectively. The continence data for 31 patients at a mean follow-up of 20.1 months (median 12.0) showed that all but 1 patient (97%) had daytime and nighttime continence. Conclusion: Patients undergoing robotic-assisted laparoscopic radical cystectomy with Indiana pouch continent cutaneous urinary diversion reconstruction have comparable complication rates and functional outcomes compared with patients in the open series. © 2012 Elsevier Inc. All rights reserved.
Barbosa, J. A., A. Kowal, et al. (2012). “Comparative evaluation of the resolution of hydronephrosis in children who underwent open and robotic-assisted laparoscopic pyeloplasty.” Journal of Pediatric Urology.
Objectives: To assess long-term postoperative ultrasonographic outcomes of robotic-assisted laparoscopic pyeloplasty (RALP) and of conventional open pyeloplasty (COP) in pediatric patients with ureteropelvic junction obstruction. Methods: Retrospective review of 312 patients who underwent RALP or COP in a single institution. Preoperative and postoperative ultrasounds were used to determine the grade of hydronephrosis. Postoperative assessment included 3 ultrasounds at 0-6, 6-12 and >12 months intervals. Patients were matched by age, etiology of obstruction, grade of preoperative hydronephrosis and gender for case-matched analysis. Results: We identified 212 pyeloplasties that met inclusion criteria, being 58 RALP and 154 COP. Groups were different in age, gender and etiology, but similar in severity of hydronephrosis and follow-up time. At the end of follow-up, complete resolution and success rates were 62% and 74% in RALP and 45% and 70% in COP, respectively. Matching included 105 patients. Complete resolution was higher in RALP (p = 0.004), while median time before improvement was lower (12.3 months RALP vs 29.9 months COP). There was no difference in success rate at the end of follow-up between the groups. Conclusion: RALP shows satisfactory long-term outcomes, comparable to COP. In our cohort, patients who underwent robotic pyeloplasty showed faster resolution of hydronephrosis on ultrasound. © 2012 Journal of Pediatric Urology Company.
Ferguson, J. E., R. Goyal, et al. (2012). “COST ANALYSIS OF ROBOT-ASSISTED LAPAROSCOPIC VERSUS HAND-ASSISTED LAPAROSCOPIC PARTIAL NEPHRECTOMY.” Journal of Endourology.
Objective: To perform a cost-comparison of three approaches to partial nephrectomy (PN): open (OPN), hand-assisted laparoscopic (HALPN), and robot-assisted (RAPN). Subjects and Methods: We retrospectively evaluated cost and clinical data from patients undergoing OPN, HALPN, and RAPN from 2007 to 2010 (n=89). Baseline demographic data, patient comorbidities, R.E.N.A.L. nephrometry score, and perioperative outcomes were assessed. Costs and subcosts from the OR and hospital were evaluated using non-parametric statistical analyses. Results: Patient demographics and tumor characteristics were similar between HALPN and RAPN, while OPN patients had more comorbidities and more difficult-to-resect tumors. Thus, HALPN and RAPN were directly compared, while OPN were excluded from the analysis. No difference was found in overall costs between HALPN and RAPN ($13560 vs $13439, p=0.29). OR costs were higher for RAPN ($7276 v $5708, p=0.0001) due to higher robotic capital and reusable equipment costs which outweighed higher disposable costs in the HALPN group. OR time-related costs were similar between groups. RAPN patients had a shorter length of stay (LOS) which decreased post-op hospital costs ($4371 v $5984, p=0.002). Conclusions: No difference in overall cost was found between RAPN and HALPN. Robot allocation, OR equipment use, and LOS are important determinants of total cost. Further study regarding recovery and quality of life may reveal added benefits to minimally-invasive approaches and increase utilization of nephron-sparing surgery.
Kim, P. H., M. B. Patil, et al. (2012). “Early comparison of nephrectomy options in children (open, transperitoneal laparoscopic, laparo-endoscopic single site (LESS), and robotic surgery).” BJU International109(6): 910-915.
OBJECTIVE To compare the perioperative parameters of paediatric patients who underwent nephrectomy via laparo-endoscopic single site (LESS) surgery (also known as single incision laparoscopic surgery or SILS) with those who underwent nephrectomy via conventional laparoscopy (LAP), robotic-assisted laparoscopy (RALN), and open surgery (OPEN). PATIENTS AND METHODS The medical records of 69 paediatric patients at a single institution who underwent nephrectomies for non-functioning kidneys in 72 renal units (39 OPEN, 11 LAP, 11 RALN and 11 LESS) were reviewed for patient demographics and perioperative clinical parameters. RESULTS The minimally invasive modalities in children, including LESS nephrectomy, were associated with shorter lengths of hospital stay (P < 0.001) and decreased postoperative pain medication usage (P < 0.001) than with open surgery. Similar surgical times were noted with LESS and the other minimally invasive modalities (LAP and RALN) (P= 0.056). However, the minimally invasive modalities (LESS, LAP and RALN) were associated with slightly longer surgical times when compared with open surgery (P < 0.001), which may, in part, be secondary to learning curve factors. No differences were noted among the minimally invasive modalities for postoperative pain medication usage (P= 0.354) and length of hospital stay (P= 0.86). CONCLUSIONS The minimally invasive modalities for nephrectomy in children, including LESS nephrectomy, are associated with shorter lengths of hospital stay and decreased postoperative pain medication use when compared with open surgery. LESS nephrectomy in children is associated with similar surgical times, lengths of hospital stay and postoperative pain medication use as the other minimally invasive modalities (LAP and RALN). Slightly longer surgical times are noted with the minimally invasive modalities, including LESS nephrectomy, when compared with open surgery, which may, in part, be secondary to learning curve factors. © 2011 THE AUTHORS. BJU INTERNATIONAL © 2011 BJU INTERNATIONAL.
Niver, B. E., I. Agalliu, et al. (2012). “Analysis of robotic-assisted laparoscopic pyleloplasty for primary versus secondary repair in 119 consecutive cases.” Urology 79(3): 689-694.
Objective: To analyze the outcomes of our robotic-assisted pyeloplasty series for primary ureteropelvic junction obstruction (UPJO) and compare them with our series of robotic-assisted pyeloplasty for secondary UPJO. The repair of secondary UPJO can pose additional challenges to surgeons. Robotic assistance could aid in these repairs. Methods: Using an institutional review board-approved database, we reviewed 119 consecutive patients who had undergone robotic-assisted laparoscopic pyeloplasty at our institution during an 8-year period (May 2002 to February 2010). Data were collected in a combined retrospective and prospective manner. The patients were stratified into primary repair and secondary repair for the primary analysis. The patients were also stratified into those with stones and those without stones for the secondary analysis. We compared the demographic, operative, postoperative, and radiographic outcomes. Student’s t test and Pearson’s chi-square correlation were used for statistical analysis of continuous and categorical variables, respectively. Results: Of the original 119 patients, data were available for 117. Of the 117 patients, 97 had undergone primary pyeloplasty repair and 20 had undergone secondary pyleloplasty repair. Radiographic data were available for 84 patients with primary repair and 17 patients with secondary repair. The radiographic success rate was 96.1% and 94.1%, respectively. No statistically significant differences were found in the patient demographics, operative data, or postoperative or radiographic outcomes for the primary analysis. Additionally, no differences were found in the outcomes for patients with concomitant stone disease. Conclusion: These data represent the largest single-center report of its kind. These data strongly suggest that robotic-assisted laparoscopic pyeloplasty is a safe and durable option for secondary UPJO repair. © 2012 Elsevier Inc.
Passerotti, C. C., R. Pessoa, et al. (2012). “Robotic-assisted laparoscopic partial nephrectomy: initial experience in Brazil and a review of the literature.” International Braz J Urol 38(1): 69-76.
Context and Purpose: Partial nephrectomy has become the standard of care for renal tumors less than 4 cm in diameter. Controversy still exists, however, regarding the best surgical approach, especially when minimally invasive techniques are taken into account. Robotic-assisted laparoscopic partial nephrectomy (RALPN) has emerged as a promising technique that helps surgeons achieve the standards of open partial nephrectomy care while offering a minimally invasive approach. The objective of the present study was to describe our initial experience with robotic-assisted laparoscopic partial nephrectomy and extensively review the pertinent literature. Materials and Methods: Between August 2009 and February 2010, eight consecutive selected patients with contrast enhancing renal masses observed by CT were submitted to RALPN in a private institution. In addition, we collected information on the patients ‘ demographics, preoperative tumor characteristics and detailed operative, postoperative and pathological data. In addition, a PubMed search was performed to provide an extensive review of the robotic-assisted laparoscopic partial nephrectomy literature. Results: Seven patients had RALPN on the left or right sides with no intraoperative complications. One patient was electively converted to a robotic-assisted radical nephrectomy. The operative time ranged from 120 to 300 min, estimated blood loss (EBL) ranged from 75 to 400 mL and, in five cases, the warm ischemia time (WIT) ranged from 18 to 32 min. Two patients did not require any clamping. Overall, no transfusions were necessary, and there were no intraoperative complications or adverse postoperative clinical events. All margins were negative, and all patients were disease-free at the 6-month follow-up. Conclusions: Robotic-assisted laparoscopic partial nephrectomy is a feasible and safe approach to small renal cortical masses. Further prospective studies are needed to compare open partial nephrectomy with its minimally invasive counterparts.
Sun, M., Q. D. Trinh, et al. (2012). “Reply from authors re: Alexander Kutikov, Marc C. Smaldone, Brian L. Egleston, Robert G. Uzzo. Should partial nephrectomy be offered to all patients whenever technically feasible? Eur Urol 2012;61:732-4.” European Urology 61(4): 734-735.
Thom, M. R., M. Haseebuddin, et al. (2012). “Robot-assisted pyeloplasty: Outcomes for primary and secondary repairs, a single institution experience.” International Braz J Urol 38(1): 77-83.
Introduction: Robotic Pyeloplasty (RAP) is a technique for management of ureteropelvic junction obstruction (UPJO). Purpose: To report outcomes of RAP for primary and secondary (after failed primary treatment) UPJO. Materials and Methods: Single institution data of adult RAP performed from 2007 to 2009 was collected retrospectively following approval by our IRB. Database analysis included patient age, race, pre and post-operative imaging studies and perioperative variables including operative time, blood loss, pain and complications. Results: Fifty-five adult patients underwent RAP (26 left/29 right) for UPJO including 9 secondary procedures from 2007 to 2009. Average follow-up was 16 months (1-36). Mean age was 41 years (18-71) with an average BMI of 27 (17-42); 32 were female. Most patients were diagnosed with preoperative diuretic renal scintigraphy and the obstructed side demonstrated mean function of 41% and t1/2 of 70 minutes. Mean operative time was 194 minutes with average blood loss less than 100 mL. Mean hospital stay was 1.7 days with an average narcotic equivalent dose of 15 mg. RAP for secondary UPJO took longer with more blood loss and had a lower success rate. Failure was defined as the need of another procedure due to persistent pain and/or obstruction after diuretic renal imaging. One patient (2%) with primary UPJO failed and 2 patients (22%) with secondary UPJO failed. One major complication occurred. Conclusion: RAP is a good option for the treatment of patients with UPJO. Reported series have established that endopyelotomy has inferior success rate for the treatment of primary UPJO which compromises the success of subsequent treatment as demonstrated in our higher failure rate with secondary UPJO repair.
Ahmed, K., A. Ibrahim, et al. (2012). “Assessing the cost effectiveness of robotics in urological surgery – a systematic review.” BJU International.
Study Type – Therapy (systematic review) Level of Evidence 1a What’s known on the subject? and What does the study add? Research on the subject has shown that robotic surgery is more costly than both laparoscopic and open approaches due to the initial cost of purchase, annual maintenance and disposable instruments. However, both robotic and laparoscopic approaches have reduced blood loss and hospital stay and robotic procedures have better short term post-operative outcomes such as continence and sexual function. Some studies indicate that the robotic approach may have a shorter learning curve. However, factors such as reduced learning curve, shorter hospital stay and reduced length of surgery are currently unable to compensate for the excess costs of robotic surgery. This review concludes that robotic surgery should be targeted for cost efficiency in order to fully reap the benefits of this advanced technology. The excess cost of robotic surgery may be compensated by improved training of surgeons and therefore a shorter learning curve; and minimising costs of initial purchase and maintenance. The review finds that only a few studies gave an itemised breakdown of costs for each procedure, making accurate comparison of costs difficult. Furthermore, there is a lack of long term follow up of clinical outcomes, making it difficult to accurately assess long term post-operative outcomes. A breakdown of costs and studies of long term outcomes are needed to accurately assess the effectiveness of robotic surgery in urology. OBJECTIVES: * Although robotic technology is becoming increasingly popular for urological procedures, barriers to its widespread dissemination include cost and the lack of long term outcomes. This systematic review analyzed studies comparing the use of robotic with laparoscopic and open urological surgery. * These three procedures were assessed for cost efficiency in the form of direct as well as indirect costs that could arise from length of surgery, hospital stay, complications, learning curve and postoperative outcomes. METHODS: * A systematic review was performed searching Medline, Embase and Web of Science databases. Two reviewers identified abstracts using online databases and independently reviewed full length papers suitable for inclusion in the study. RESULTS: * Laparoscopic and robot assisted radical prostatectomy are superior with respect to reduced hospital stay (range 1-1.76 days and 1-5.5 days, respectively) and blood loss (range 482-780 mL and 227-234 mL, respectively) when compared with the open approach (range 2-8 days and 1015 mL). Robot assisted radical prostatectomy remains more expensive (total cost ranging from US $2000-$39 215) than both laparoscopic (range US $740-$29 771) and open radical prostatectomy (range US $1870-$31 518). * This difference is due to the cost of robot purchase, maintenance and instruments. The reduced length of stay in hospital (range 1-1.5 days) and length of surgery (range 102-360 min) are unable to compensate for the excess costs. * Robotic surgery may require a smaller learning curve (20-40 cases) although the evidence is inconclusive. CONCLUSIONS: * Robotic surgery provides similar postoperative outcomes to laparoscopic surgery but a reduced learning curve. * Although costs are currently high, increased competition from manufacturers and wider dissemination of the technology could drive down costs. * Further trials are needed to evaluate long term outcomes in order to evaluate fully the value of all three procedures in urological surgery.
Bhandari, A. (2012). “Editorial Comment for Coelho et al.” Journal of Endourology 26(3): 270.
Kamel, M. H., C. M. Jackson, et al. (2012). “Post-chemotherapy robotic retroperitoneal lymph node dissection (RRPLND) in testicular cancer.” Journal of Robotic Surgery: 1-4.
We report here on the safety and feasibility of using robotic surgery for the excision of residual retroperitoneal lymph node metastasis in patients with non-seminomatous germ cell testicular tumors (NSGCT) post-chemotherapy (PC). Two men (age 20 and 21 years, respectively) with residual PC retroperitoneal disease underwent robotic assisted retroperitoneal lymph node dissection (RRPLND). The primary testicular tumor was on the right testicle in one patient and on the left testicle in the other patient. Both patients had a history of testicular NSGCT and bulky retroperitoneal lymph node metastasis and had received chemotherapy. The technique, feasibility, and safety of the RRPLND procedure are reported. RRPLND was safely accomplished in both patients. A right-side approach was performed in one patient; a left-side approach was utilized in the other patient. In both patients, the field of dissection was an ipsilateral template for lymph node dissection, including excision of the residual mass. No intraoperative or postoperative complications were encountered. Pathology showed mature teratomatous elements in both patients. We demonstrate here the safety and feasibility of performing template RRPLND in patients with PC residual masses. Further reports are needed to compare this procedure to its other approaches, namely, standard open and laparoscopic RPLND. © 2012 Springer-Verlag London Ltd.
Khanna, R., R. J. Stein, et al. (2012). “Single institution experience with robot-assisted laparoendoscopic single-site renal procedures.” Journal of Endourology 26(3): 230-234.
Background and Purpose: The desire to decrease morbidity from multiple port sites and progress toward a natural orifice approach has stimulated interest in laparoendoscopic single-site (LESS) surgery. Limitations, however, including clashing of instruments and loss of triangulation, have prevented widespread dissemination of LESS. To overcome these problems, the advantages of the robotic platform have been applied to single-site surgery. The objective of this article is to review our experience and summarize the current literature pertaining to robot-assisted LESS renal surgery. Patients and Methods: Twenty-eight robot-assisted LESS kidney procedures were identified from our prospectively maintained LESS database. These included 11 radical nephrectomies, 5 partial nephrectomies, 3 nephroureterectomies, 7 pyeloplasties, 1 simple nephrectomy, and 1 renal cyst decortication. Perioperative and postoperative data were analyzed. Results: Of 28 cases, 4 conversions occurred. The remaining procedures were performed with no extraincisional trocars. Mean follow-up was 11.3 months for radical nephrectomy, 21.3 months for partial nephrectomy, 17.8 months for nephroureterectomy, 12.9 months for pyeloplasty, 4 months for simple nephrectomy, and 1.6 months for renal cyst decortication. Patients who underwent radical nephrectomy, partial nephrectomy, and nephroureterectomy all had negative surgical margins and have remained disease free during the follow-up period. Six of seven patients who underwent pyeloplasty reported complete resolution of symptoms while the seventh reports significant improvement. Conclusion: We present a large experience with robot-assisted LESS kidney surgery demonstrating the wide variety of procedures that can be performed. Further follow-up of this patient population is needed to document continued oncologic efficacy and durability of results. © 2012, Mary Ann Liebert, Inc.
Alemozaffar, M., A. Duclos, et al. (2012). “Technical Refinement and Learning Curve for Attenuating Neurapraxia During Robotic-Assisted Radical Prostatectomy to Improve Sexual Function.” European Urology.
Background: While radical prostatectomy surgeon learning curves have characterized less blood loss, shorter operative times, and fewer positive margins, there is a dearth of studies characterizing learning curves for improving sexual function. Additionally, while learning curve studies often define volume thresholds for improvement, few of these studies demonstrate specific technical modifications that allow reproducibility of improved outcomes. Objective: Demonstrate and quantify the learning curve for improving sexual function outcomes based on technical refinements that reduce neurovascular bundle displacement during nerve-sparing robot-assisted radical prostatectomy (RARP). Design, setting, and participants: We performed a retrospective study of 400 consecutive RARPs, categorized into groups of 50, performed after elimination of continuous surgeon/assistant neurovascular bundle countertraction. Surgical procedure: Our approach to RARP has been described previously. A single-console robotic system was used for all cases. Outcome measurements and statistical analysis: Expanded Prostate Cancer Index Composite sexual function was measured within 1 yr of RARP. Linear regression was performed to determine factors influencing the recovery of sexual function. Results and limitations: Greater surgeon experience was associated with better 5-mo sexual function (p = 0.007) and a trend for better 12-mo sexual function (p = 0.061), with improvement plateauing after 250-300 cases. Additionally, younger patient age (both p < 0.02) and better preoperative sexual function (<0.001) were associated with better 5- and 12-mo sexual function. Moreover, trainee robotic console time during nerve sparing was associated with worse 12-mo sexual function (p = 0.021), while unilateral nerve sparing/non-nerve sparing was associated with worse 5-mo sexual function (p = 0.009). Limitations include the retrospective single-surgeon design. Conclusions: With greater surgeon experience, attenuating lateral displacement of the neurovascular bundle and resultant neurapraxia improve postoperative sexual function. However, to maximize outcomes, appropriate patient selection must be exercised when allowing trainee nerve-sparing involvement. © 2012 European Association of Urology.
Babayan, R. K. (2012). “Re: heparin prophylaxis and the risk of venous thromboembolism after robotic-assisted laparoscopic prostatectomy.” Journal of Urology 187(4): 1269-1270.
Binhas, M., L. Salomon, et al. (2012). “Radical prostatectomy with robot-assisted radical prostatectomy and laparoscopic radical prostatectomy under low-dose aspirin does not significantly increase blood loss.” Urology79(3): 591-595.
Objective: To determine whether maintaining use of low-dose aspirin confers a higher risk of bleeding events in patients undergoing laparoscopic or robot-assisted radical prostatectomy. There is no consensus on maintaining or withdrawing aspirin in these patients. Methods: Consecutive patients undergoing laparoscopic and robot-assisted radical prostatectomy between January 2009 and December 2010 were included in a prospective cohort study. Among them, 54 aspirin-treated patients were compared with 569 nonaspirin-treated patients. We evaluated the between-group difference in bleeding event: intraoperative blood loss < 700 ml and/or need for transfusion and/or postoperative hemorrhagic complication (symptomatic abdominal wall hematomas, major bleeding requiring reoperation). Differences in each component of the bleeding event, in hemoglobin level changes, and hospital stay length were also evaluated. Patients’ data were compared using the χ 2 or Fisher exact test for categorical variables and the Student t test or MannWhitney test for continuous variables. Results: A bleeding event occurred in 18 (33.3%) aspirin-treated patients and 176 (32.5%) nonaspirin-treated patients (P =.66). Median blood loss was similar in the 2 groups (aspirin: 450 ml, 50-7100 ml; no aspirin: 450 ml, 100-2800 ml; P =.93). Aspirin was not associated with a significant hemoglobin level variation (median decrease, 2.9 g/dL with aspirin and 3.2 g/dL without aspirin, P =.23). Median hospital length of stay, rates of blood transfusion, and postoperative hemorrhagic complications were similar in the 2 groups. Conclusion: Laparoscopic and robot-assisted radical prostatectomy can be performed safely without discontinuing aspirin, as this policy does not increase significantly blood loss, blood transfusion requirements, postoperative hemorrhagic complications. or hospital length of stay. © 2012 Elsevier Inc.
Cestari, A., M. Sangalli, et al. (2012). “Robotic assisted radical prostatectomy in morbidly obese patients: how to create a cost-effective adequate optical trocar.” Journal of Robotic Surgery: 1-5.
Obesity is a major health issue in modern society, and with the progressive widespread employment of robotic assisted radical prostatectomy (RALP), the urologist-robotic surgeon is increasingly involved in the treatment of obese patients. However, the vast majority of urological departments are not equipped with a complete set of bariatric instruments. One of the potential difficulties of robotic surgery on the morbidly obese patient is the relatively short length of the optical trocar sheath, as the optical robotic arm requires some very valuable centimeters of the sheath to hang onto. This condition may make it impossible to properly reach the peritoneal cavity with the optical trocar during the RALP procedure. We present a series of four morbidly obese patients (BMI ranging from 42.1 to 46.2) with localized prostate cancer treated with RALP. We have developed an effective and “easy-to-implement” solution to the problem of properly elongating the sheath of the optical trocar which involves the use of the plastic cylindrical transparent protective tube of a disposable 26-Ch Amplatz sheath. The Amplatz sheath, with an internal diameter of 13 mm and length of 25 cm, perfectly fits outside of the 13-mm trocar usually employed for the optical trocar. Additionally, the cylindrical tube perfectly fits and hangs onto the robotic optical arm system. Mean operative time was 202.5 min (range 185-220 min). Mean blood loss was 284 mL (range 185-380 mL). Catheterization time and hospital stay were 5 and 6 days, respectively, in all patients. All procedures were safely completed, and no minor or major complications were reported. The optical trocar lengthening technique allowed us to properly perform RALP procedures even in severely morbidly obese patients in an urological setting not equipped for bariatric minimally invasive surgery. © 2012 Springer-Verlag London Ltd.
Coelho, R. F., S. Chauhan, et al. (2012). “Does the presence of median lobe affect outcomes of robot-assisted laparoscopic radical prostatectomy?” Journal of Endourology 26(3): 264-270.
Purpose: To determine whether the presence of median lobe (ML) affects perioperative outcomes, positive surgical margin (PSM) rates, and recovery of urinary continence after robot-assisted radical prostatectomy (RARP). Patients and Methods: We analyzed 1693 consecutive patients undergoing RARP performed by a single surgeon. Patients were analyzed in two groups based on the presence or not of a ML identified during RARP. Perioperative outcomes, PSM rates, and recovery of urinary continence were compared between the groups. Continence was assessed using validated questionnaires, and it was defined as the use of “no pads” postoperatively. Results: A ML was identified in 323 (19%) patients. Both groups had similar estimated blood loss, length of hospital stay, pathologic stage, complication rates, anastomotic leakage rates, overall PSM rates, and PSM rate at the bladder neck. The median overall operative time was slightly greater in patients with ML (80 vs 75min, P<0.001); however, there was no difference in the operative time when stratifying this result by prostate weight. Continence rates were also similar between patients with and without ML at 1 week (27.8% vs 27%, P=0.870), 4 weeks (42.3% vs 48%, P=0.136), 12 weeks (82.5% vs 86.8%, P=0.107), and 24 weeks (91.5% vs 94.1%, P=0.183) after catheter removal. Finally, the median time to recovery of continence was similar between the groups (median: 5wks, 95% confidence interval [CI]: 4.41-5.59 vs median: 5wks, CI 4.66-5.34; log rank test, P=0.113). Conclusion: The presence of a ML does not affect outcomes of RARP performed by an experienced surgeon. © 2012, Mary Ann Liebert, Inc.
Fuller, A. and S. E. Pautler (2012). “Complications following robot-assisted radical prostatectomy in a prospective Canadian cohort of 305 consecutive cases.” Canadian Urological Association Journal: 1-6.
BACKGROUND: Robot-assisted radical prostatectomy (RARP) has emerged in the last decade as an alternative to open radical prostatectomy for men with localized prostate cancer. The increased cost of this technique has been justified by its ability to reduce blood loss, and to provide improved vision, less postoperative pain and more rapid recovery from surgery, while maintaining satisfactory oncological and functional outcomes. Given the increasing diffusion of robotic surgical technology within Canada and its associated high capital and operating costs, we review the clinical outcomes and complications from 305 consecutive cases performed at our Canadian institution. METHODS: A consecutive cohort of 305 patients with a mean follow-up of 30 months was analyzed with institutional ethics approval. All patients were treated and reviewed postoperatively by a single surgeon (SP). The primary aim of the study was to assess the incidence and type of complications associated with RARP in a Canadian setting. Our prospective database captured preoperative, intra-operative and postoperative data and was maintained by an individual independent of the robotic program. We report complications categorized according to the Clavien system. Multiple complications seen in an individual were recorded separately for the purposes of our analysis. RESULTS: Between April 2005 and October 2010, 305 patients underwent RARP at our institution. A total of 70 complications were identified, with 47 (67.1%) requiring only conservative or pharmacological management (Clavien I-II). Twenty-three patients were found to have a major complication (Clavien III-V). Of the 16 who required intervention under general anesthesia, 3 required emergency treatment and the remaining patients underwent elective surgery. CONCLUSIONS: RARP has been incorporated at our institution with an acceptably low rate of intra-operative and postoperative complications. We have found that the database was effective in providing patients with outcome-related information, which in turn helped us gain patient consent with regard to the institution-specific risks of RARP.
Gainsburg, D. M. (2012). “Anesthetic concerns for robotic-assisted laparoscopic radical prostatectomy.”Minerva Anestesiologica.
The anesthetic concerns of patients undergoing robotic-assisted radical prostatectomy (RALP) are primarily related to the use of pneumoperitoneum in the steep Trendelenburg position. This combination will affect cerebrovascular, respiratory and hemodynamic homeostasis. Possible non-surgical complications range from mild subcutaneous emphysema to devastating ischemic optic neuropathy. The anesthetic management of RALP patients involves a thorough preoperative evaluation, careful positioning on the operative table, managing ventilation issues, and appropriate fluid management. Close coordination between the anesthesia and surgical teams is required for a successful surgery. This review will discuss the anesthetic concerns and perioperative management of patients presenting for RALP.
Hong, H., L. Mel, et al. (2012). “Effects of robotic-assisted laparoscopic prostatectomy on surgical pathology specimens.” Diagnostic Pathology: 24.
Background: Robotic-assisted laparoscopic prostatectomy (RALP) has greatly changed clinical management of prostate cancer. It is important for pathologists and urologists to compare RALP with conventional open radical retropubic prostatectomy (RRP), and evaluate their effects on surgical pathology specimens. Methods: We retrospectively reviewed and statistically analyzed 262 consecutive RALP (n = 182) and RRP (n = 80) procedures performed in our institution from 2007 to 2010. From these, 49 RALP and 33 RRP cases were randomly selected for additional microscopic examination to analyze the degree of capsular incision and the amount of residual prostate surface adipose tissue. Results: Positive surgical margins were present in 28.6% RALP and 57.5% RRP cases, a statistically significant difference. In patients with stage T2c tumors, which represent 61.2% RALP and 63.8% RRP patients, the positive surgical margin rate was 24.1% in the RALP group and 58.8% in the RRP group (statistically significant difference). For other pathologic stages, the differences in positive margins between RALP and RRP groups were not statistically significant. The incidence of positive surgical margins after RALP was related to higher tumor stage, higher Gleason score, higher tumor volume and lower prostate weight, but was not related to the surgeons performing the procedure. When compared with RRP, RALP also caused less severe prostatic capsular incision and maintained larger amounts of residual surface adipose tissue in prostatectomy specimens. Conclusions: In this study RALP showed a statistically significant lower positive surgical margin rate than RRP. Analysis of capsular incision and amount of prostatic surface residual adipose tissue suggested that RALP caused less prostatic capsular damage than RRP.
Jeong, C. W., J. J. Oh, et al. (2012). “Novel posterior reconstruction technique during robot-assisted laparoscopic prostatectomy: Description and comparative outcomes.” International Journal of Urology.
The aim of the present study was to assess the impact of a novel posterior reconstruction technique during robot-assisted laparoscopic prostatectomy on continence recovery. A total of 116 consecutive patients who received the novel posterior reconstruction (case group) were retrospectively compared with a cohort of 126 patients who did not receive posterior reconstruction (control group). The primary end-point was the duration of continence recovery (no pad use) after robot-assisted laparoscopic prostatectomy. The posterior reconstruction was obtained by opposing the median dorsal fibrous raphe to the posterior counterpart of the detrusor apron, rather than the Denonvilliers’ fascia. The case group showed higher continence rates at all points of evaluation, which were 2 weeks (30.1% vs 19.8%), 1 month (58.4% vs 45.7%), 3 months (82.7% vs 70.5%) and 6 months postoperatively (95.3% vs 86.4%) (P = 0.007). Application of the novel posterior reconstruction technique, age and length of membranous urethra were significant variables for the complete recovery of continence on multivariable analysis. This study shows that the application of this novel PR technique significantly improves the recovery of continence in patients undergoing robot-assisted laparoscopic prostatectomy.
Manganiello, M., P. Kenney, et al. (2012). “Unidirectional barbed suture versus standard monofilament for urethrovesical anastomosis during robotic assisted laparoscopic radical prostatectomy.” International Braz J Urol 38(1): 89-96.
Purpose: V-Loc (TM)180 (Covidien Healthcare, Mansfield, MA) is a new unidirectional barbed suture that may reduce loss of tension during a running closure. We evaluated the use of the barbed suture for urethrovesical anastomosis (UVA) during robotic assisted laparoscopic prostatectomy (RALP). Time to completion of UVA, post-operative anastomotic leak rate, and urinary incontinence were compared in patients undergoing UVA with 3-0 unidirectional-barbed suture vs. 3-0 Monocryl (TM) (Ethicon, Somerville, NJ). Materials and Methods: Data were prospectively collected for 70 consecutive patients undergoing RALP for prostate cancer between November 2009 and October 2010. In the first 35 patients, the UVA was performed using a modified running van Velthoven anastomosis technique using two separate 3-0 monofilament sutures. In the subsequent 35 patients, the UVA was performed using two running novel unidirectional barbed sutures. At 7-12 days postoperatively, all patients were evaluated with a cystogram to determine anastomotic integrity. Urinary incontinence was assessed at two months and five months by total daily pad usage. Clinical symptoms suggestive of bladder neck contracture were elicited. Results: Age, PSA, Gleason score, prostate size, estimated blood loss, body mass index, and clinical and pathologic stage between the 2 groups were similar. Comparing the monofilament group and V-Loc (TM)180 cohorts, average time to complete the anastomosis was similar (27.4 vs. 26.4 minutes, p = 0.73) as was the rate of urinary extravasation on cystogram (5.7 % vs. 8.6%, p = 0.65). There were no symptomatic bladder neck contractures noted at 5 months of follow-up. At 2 months, the percentage of patients using 2 or more pads per day was lower in the V-Loc (TM)180 cohort (24% vs. 44%, p < 0.02). At 5 months, this difference was no longer evident. Conclusions: Time to complete the UVA was similar in the intervention and control groups. Rates of urine leak were also comparable. While the V-Loc(TM)180 was associated with improved early continence, this difference was transient.
Namiki, K. and K. Yoshioka (2011). “[Robotic-assisted laparoscopic radical prostatectomy].” Nihon Rinsho 69 Suppl 5: 360-364.
Nowfar, S., R. Kopp, et al. (2012). “Initial experience with aspirin use during robotic radical prostatectomy.”Journal of Laparoendoscopic and Advanced Surgical Techniques. Part A 22(3): 225-229.
Abstract Background: New cardiology guidelines recommend antiplatelet therapy for some patients with cardiac stents. Aspirin use is relatively contraindicated during urologic surgery because of increased bleeding risk. We sought to review the outcomes of patients who continued aspirin during robot-assisted radical prostatectomy. Patients and Methods: Between October 2007 and February 2010, 249 patients underwent robot-assisted radical prostatectomy by a single surgeon. After consultation with the patients’ cardiologists, 6 patients had coronary artery stents and continued aspirin perioperatively (Group 1), and 7 patients had coronary artery stents but did not continue aspirin perioperatively (Group 2). The remaining 236 patients had no coronary artery stents and did not require continued aspirin (Group 3). We analyzed our patients’ preoperative characteristics, including age, prostate-specific antigen volume, and D’Amico risk, as well as operative time, blood loss, hematocrit changes, transfusion requirements, length of hospital stay, and complications. Results: We found no differences in operative time, estimated blood loss, changes in hematocrit, or length of hospital stay. No patients with any type of cardiac stent required a postoperative blood transfusion or had complications requiring more than simple anti-emetics, analgesics, or electrolyte correction. Nine patients in Group 3 required interventions for significant complications. Conclusion: Larger studies need to be performed to validate these observations.
Philippou, P., E. Waine, et al. (2012). “Robotically-assisted laparoscopic prostatectomy versus open: comparison of the learning curve of a single surgeon.” Journal of Endourology.
Objective To prospectively compare the functional and oncological outcome of the first 50 open Radical Retropubic Prostatectomies (RRP) versus the first 50 Robotically-Assisted Laparoscopic Prostatectomies (RALP), in a single surgeon series. Patients and Methods Baseline patient and tumour characteristics, intra- and peri-operative parameters and complications (Clavien classification) were recorded prospectively. Final histopathological data, 12-month biochemical recurrence-free rates (BRFR), and early functional outcomes (potency and continence at 3 months) were used as points for comparison. Results The preoperative patient and tumour parameters were comparable between the two groups. The mean operative time was 125 minutes for RRP and 212 minutes for RALP (p<0.001). There were no conversions from RALP to open. Mean estimated blood loss was 513 mL for RRP and 132 mL for RALP (p<0.001). Transfusion rates in RRP and RALP were 8% and 2% respectively (p=0.362). Mean hospital stay was 3.82 (2-7) days for RRP and 1.30 (1-3) days for RALP (p<0.001). Major complication rates (Clavien 3+4) for RRP and RALP were 12% and 6% respectively; minor complication rates (Clavien 1+2) were 18% and 10% respectively. The overall PSM rates were 20% for RRP and 18% for RALP (p=0.799). For pT3 disease, the PSM rates were 26.1% for RRP and 22.2%% for RALP (p=0.53). The 12-month BRFR were 88% for RRP and 92% for RALP (p=0.505). The 3-month continence rates were 88% for RRP and 90% for RALP (p=0.749). Among patients who were potent preoperatively, early (3-month) potency was achieved in 60.6% in the RRP group and in 62.1% in the RALP group (p=0.893). Conclusion In this study, the oncological and functional outcomes were equivalent during the early learning curves RRP and RALP. It would appear that the early learning curve for RALP does not confer any increased risk to the patient when compared to open surgery.
Rocco, B., G. Cozzi, et al. (2012). “Current Status of Salvage Robot-Assisted Laparoscopic Prostatectomy for Radiorecurrent Prostate Cancer.” Current Urology Reports: 1-7.
Radiation therapy (RT) is one of the treatment options for prostate cancer (PCa). Transperineal low-dose rate brachytherapy (BT) is another safe and effective technique for low-risk PCa. Recurrence after RT for localized PCa can be defined by a PSA value of 2 ng/mL above the nadir after RT, and biochemical recurrence (BCR) rate after RT is 40-60 %. In case of radiorecurrent PCa, treatment options include salvage radical prostatectomy (RP), cryotherapy, high-intensity focused ultrasound (HIFU), and salvage BT. Only salvage RP has cancer control results for over 10-year follow-up in a substantial portion of patients (30-40 %). However, salvage RP is technically demanding, and experienced surgeons are needed; in fact, RT-induced cystitis, fibrosis, and tissue plane obliteration can lead to significant complications, such as rectal injuries, anastomotic stricture, and urinary incontinence. This review describes indications, oncologic and functional outcomes, surgical techniques, and complications of salvage robot-assisted RP. © 2012 Springer Science+Business Media, LLC.
Romero-Gonzalez, R. J., J. F. Lopez-Verdugo, et al. (2011). “[Robot-assisted laparoscopic radical cystoprostatectomy and construction of totally intraabdominal orthotopic bladder with ileal segment. Initial experience in Mexico].” Cirugia y Cirujanos 79(5): 468-472.
Background: Bladder and surrounding tissue resection followed by creation of a continent urinary reservoir is the gold standard treatment for invasive bladder cancer. In recent years, the da Vinci robot has played a major role in this procedure. Our objective was to describe our surgical technique, a robot-assisted laparoscopic radical cystoprostatectomy and totally intrabdominal ortothopic ileal neobladder construction (Studer). Clinic case: We present the case of a 79-year-old male patient with a diagnosis of transitional cell bladder carcinoma. The patient underwent radical cystoprostatectomy with urinary diversion. The procedure was performed with the use of the da Vinci Surgical System (Intuitive Surgical, Sunnyvale, CA). Total operative time was 7 h, and the estimated blood loss was 500 ml. There were no intra- or postoperative complications, and the patient’s hospitalization was 7 days. At early follow-up, oncological and functional results were favorable. Conclusions: Robot-assisted cystoprostatectomy and urinary diversion are feasible techniques, although their role in management of infiltrative bladder cancer is not well defined.
Schatloff, O., S. Chauhan, et al. (2012). “Cavernosal nerve preservation during robot-assisted radical prostatectomy is a graded rather than an all-or-none phenomenon: Objective demonstration by assessment of residual nerve tissue on surgical specimens.” Urology 79(3): 596-600.
Objective: To demonstrate the existence of different degrees of nerve sparing (NS) (graded NS) by comparing the surgeon’s intent of NS with the residual nerve tissue on prostatectomy specimens. Methods: We performed a prospective study of 133 consecutive patients who underwent robot-assisted radical prostatectomy in January and February of 2011. The surgeon graded the amount of NS intraoperatively independently for either side as follows: 1, no NS; 2, <50% NS; 3, 50% NS; 4, 75% NS; and 5, ≥95% NS. A pathologist who was unaware of the surgeon’s score measured the area of residual nerve tissue on the posterolateral surface of the prostate. Results: A greater NS score correlated significantly with a decreasing area of residual nerve tissue on the prostatectomy specimens (P <.001). Overall, the area of residual nerve tissue on the prostatectomy specimens was significantly different among the NS groups (P <.001). On specific intergroup analysis, significant differences were found in the area of residual nerve tissue on the prostatectomy specimens between the greater NS groups: NS score 3 versus 4, median 13 mm 2 (interquartile range [IQR] 7-23) versus 3 mm 2 (IQR 0-8; P =.01); NS score 4 versus 5, median 3 mm 2 (IQR 0-8) versus 0.5 mm 2 (IQR 0-2; P =.001). Conclusion: Subjective NS classification using the surgeon’s intraoperative perception correlated significantly with the area of residual nerve tissue on the prostatectomy specimens determined by the pathologist. It is possible to intentionally tailor the amount of NS performed at surgery. This finding demonstrates that NS is a graded rather than an all-or-none phenomenon that can even go beyond the traditional concept of complete, partial, or no NS. © 2012 Elsevier Inc.
Singh, P., P. N. Dogra, et al. (2011). “Correlation between the preoperative serum prostate specific antigen, Gleason score, and clinical staging with pathological outcome following robot-assisted radical prostatectomy: An Indian experience.” Indian Journal of Cancer 48(4): 483-487.
Objectives: To correlate the preoperative serum prostate specific antigen (PSA), Gleason score, and clinical staging with pathological outcome following robot-assisted radical prostatectomy (RARP) in Indian men with clinically localized cancer prostate. Materials and Methods: A prospective study analysis was done for 166 consecutive patients of prostate cancer who underwent RARP at our center from June 2006 to October 2009. Preoperative workup included serum PSA, biopsy Gleason score, and clinical staging. The preoperative parameters were correlated with final Gleason score, capsular penetration, seminal vesicle involvement, and lymph node status on final histopathology. Results: The mean age was 64 years (range: 50-76 years) with mean and median PSA of 17.98 ng/ml (range: 0.3-68.3 ng/ml) and 12.1 ng/ml, respectively. With increase in preoperative Gleason score, chance of organ confinement decreases (P=0.002) and capsular penetration increases (P=0.004) linearly. With increasing serum PSA, there is linear decrease in trend of organ-confined disease (P=0.03) and increased chances of seminal vesicle involvement (P=0.02). Patients with higher clinical stage have less probability of localized disease (P=0.007) and more chances of capsular penetration (P=0.04) and seminal vesicle involvement (P=0.004). Conclusion: Our data suggest that patients with higher preoperative serum PSA, Gleason score, and clinical stage have more chances of advanced pathological stage following RARP.
Stolzenburg, J. U., O. Andrikopoulos, et al. (2012). “Evolution of endoscopic extraperitoneal radical prostatectomy (EERPE): Technique and outcome.” Asian Journal of Andrology 14(2): 278-284.
Endoscopic extraperitoneal radical prostatectomy (EERPE) is a well-established and standardized technique for treating patients with localized prostate cancer. Nevertheless, the procedure is continuously being refined with the expansion of anatomical knowledge. The development of a nerve-sparing approach and improvements in currently used equipment are expected to yield better results in cosmesis and convalescence without sacrificing the procedure’s established benefits in terms of potency, continence and oncological management. In this study, the technique and its evolution are presented in detail, along with an analysis of its clinical efficacy. We also consult the literature to compare EERPE to transperitoneal laparoscopic radical prostatectomy, and we also discuss new technical advancements regarding the use of robotic assistance during EERPE. © 2012 AJA, SIMM & SJTU.
Tatsugami, K. (2011). “[Current status of robot assisted radical prostatectomy in Japan].” Nihon Rinsho 69 Suppl 5: 662-666.
Tewari, A., P. Sooriakumaran, et al. (2012). “Positive Surgical Margin and Perioperative Complication Rates of Primary Surgical Treatments for Prostate Cancer: A Systematic Review and Meta-Analysis Comparing Retropubic, Laparoscopic, and Robotic Prostatectomy.” European Urology.
Context: Radical prostatectomy (RP) approaches have rarely been compared adequately with regard to margin and perioperative complication rates. Objective: Review the literature from 2002 to 2010 and compare margin and perioperative complication rates for open retropubic RP (ORP), laparoscopic RP (LRP), and robot-assisted LRP (RALP). Evidence acquisition: Summary data were abstracted from 400 original research articles representing 167 184 ORP, 57 303 LRP, and 62 389 RALP patients (total: 286 876). Articles were found through PubMed and Scopus searches and met a priori inclusion criteria (eg, surgery after 1990, reporting margin rates and/or perioperative complications, study size >25 cases). The primary outcomes were positive surgical margin (PSM) rates, as well as total intra- and perioperative complication rates. Secondary outcomes included blood loss, transfusions, conversions, length of hospital stay, and rates for specific individual complications. Weighted averages were compared for each outcome using propensity adjustment. Evidence synthesis: After propensity adjustment, the LRP group had higher positive surgical margin rates than the RALP group but similar rates to the ORP group. LRP and RALP showed significantly lower blood loss and transfusions, and a shorter length of hospital stay than the ORP group. Total perioperative complication rates were higher for ORP and LRP than for RALP. Total intraoperative complication rates were low for all modalities but lowest for RALP. Rates for readmission, reoperation, nerve, ureteral, and rectal injury, deep vein thrombosis, pneumonia, hematoma, lymphocele, anastomotic leak, fistula, and wound infection showed significant differences between groups, generally favoring RALP. The lack of randomized controlled trials, use of margin status as an indicator of oncologic control, and inability to perform cost comparisons are limitations of this study. Conclusions: This meta-analysis demonstrates that RALP is at least equivalent to ORP or LRP in terms of margin rates and suggests that RALP provides certain advantages, especially regarding decreased adverse events. © 2012 European Association of Urology.
Thiel, D. D. (2012). “Commentary on “initial experience with aspirin use during robotic radical prostatectomy”.” Journal of Laparoendoscopic and Advanced Surgical Techniques. Part A 22(3): 230.
Trinh, Q. D., M. Sun, et al. (2012). “Reply from authors re: Joshua J. Meeks, James A. Eastham. Robotic prostatectomy: The rise of the machines or judgment day. Eur Urol 2012;61:686-7: Robotic prostatectomy: Men versus machines – The machines are already here.” European Urology 61(4): 688-689.
Woo, H. H. (2012). “‘Growing up’ with laparoscopic radical prostatectomy makes a difference in early independent surgical practice.” ANZ Journal of Surgery 82(3): 99-99.
Yu, H. y., N. D. Hevelone, et al. (2012). “Hospital Volume, Utilization, Costs and Outcomes of Robot-Assisted Laparoscopic Radical Prostatectomy.” Journal of Urology.
Purpose: Although robot-assisted laparoscopic radical prostatectomy has been aggressively marketed and rapidly adopted, there is a paucity of population based utilization, outcome and cost data. High vs low volume hospitals have better outcomes for open and minimally invasive radical prostatectomy (robotic or laparoscopic) but to our knowledge volume outcomes effects for robot-assisted laparoscopic radical prostatectomy alone have not been studied. Materials and Methods: We characterized robot-assisted laparoscopic radical prostatectomy outcome by hospital volume using the Nationwide Inpatient Sample during the last quarter of 2008. Propensity scoring methods were used to assess outcomes and costs. Results: At high volume hospitals robot-assisted laparoscopic radical prostatectomy was more likely to be done on men who were white with an income in the highest quartile and age less than 50 years than at low volume hospitals (each p <0.01). Hospitals at above the 50th volume percentile were less likely to show miscellaneous medical and overall complications (p = 0.01). Low vs high volume hospitals had longer mean length of stay (1.9 vs 1.6 days) and incurred higher median costs ($12,754 vs $8,623, each p <0.01). Conclusions: Demographic differences exist in robot-assisted laparoscopic radical prostatectomy patient populations between high and low volume hospitals. Higher volume hospitals showed fewer complications and lower costs than low volume hospitals on a national basis. These findings support referral to high volume centers for robot-assisted laparoscopic radical prostatectomy to decrease complications and costs. © 2012 American Urological Association Education and Research, Inc.