Comparison the short-term effect of robot-assisted laparoscopic prostatectomy with extraperitoneal laparoscopic radical prostatectomy

Abstract

Objective To compare the short-term effect between robot-assisted laparoscopic prostatectomy (RALP) and extraperitoneal laparoscopic radical prostatectomy (ELRP).Methods Between January,2012 and December,2012,the data of 160 cases with prostate cancer was reviewed.Among them,86 cases were underwent the RALP with da Vinci S system (Intuitive Surgical Inc.).The median age was 67 years old (ranged 46-75 years) and the median preoperative t-PSA level was 15.20 μg/L (ranged 4.28-126.26 μg/L).At the same time,74 cases of ELRP were performed,in whom the median age was 68 years (ranged 45-78 years) and the median preoperative t-PSA level was 17.32 μg/L (ranged 4.65-131.35 μg/L).Perioperative data,short-term oncological control,recovery of continence and potency were analyzed retrospectively.Results All the operations were successful without conversion.In the RALP group,the median operative time was 90 min (ranged 80-145 min) and the median estimated blood loss was 60 ml (20-280 ml).In the ELRP group,the median operative time was 85 min (60-130 min) and the median estimated blood loss was 70 ml (20-300 ml).The differences of operative time and estimated blood loss in both groups were all not statistically significant (P=0.325 and P=0.466).The differences of pathological Gleason scores,the pathological stages and positive surgical margin rates in both groups were all not significant (P=0.523,P=0.739 and P=0.735).During the 10-21 months follow-up,7 cases and 5 cases were lost in RALP and ELRP group,respectively.Six cases and 5 cases were diagnosed as the biochemical recurrence and accepted the endocrine therapy in RALP and ELRP group,respectively.Equally continent results in both groups were found (P＞0.05).The neurovascular bundle preserved procedure was conducted in RALP (n =55) and ELRP (n =53) group,respectively.Better postoperative potency rates at 6 months (30 vs 18) and 12 months (40 vs 27) were found in RALP group (P=0.048 and P=0.025,respectively).Conclusion Compared to ELRP,RALP can provide similar perioperative data,short-term oncological control,recovery of postoperative continence and better postoperative potency rates. Key words: Robot-assisted; Prostate cancer; Radical prostatectomy ; Extraperitoneal approach ; Laparoscopy