MP3-06 MATCHED COMPARISON OF OUTCOMES FOLLOWING OPEN AND ROBOTIC-ASSISTED SIMPLE PROSTATECTOMY AT A SINGLE INSTITUTION

Abstract

INTRODUCTION AND OBJECTIVES: Robotic-assisted simple prostatectomy (RASP) has been demonstrated to be an acceptable alternative to open simple prostatectomy (OSP) for the treatment of high-volume symptomatic BPH. We performed a matched analysis comparing clinical and perioperative outcomes following RASP and OSP at our institution. METHODS: We identified 15 consecutive patients who underwent RASP between 2013 and 2014. They were 1:1 matched to patients from our OSP database based on preoperative prostate size ( 10 cc) by CT or ultrasound imaging, age ( 10 years), BMI ( 5), and ASA score ( 1). Perioperative and clinical data were examined. Analyses for comparison and statistical significance were performed using the paired two-tailed student’s t-test. RESULTS: Patients in the OSP group were found to be of comparable age (74.1 and 68.8, p 1⁄4 0.11), BMI (26.3 and 28.5, p 1⁄4 0.16), and ASA score (2.6 and 2.6, p 1⁄4 1.0) to the RASP group. OSP prostate size was 158.6 cc (156.1 cc in RASP group). The mean volume of tissue resected was similar between the OSP and RASP groups (112.6 cc and 104.7 cc respectively, p 1⁄4 0.42). Length of stay was significantly shorter in the RASP group (2.4 vs 6 days, p <0.05) with less inpatient narcotic usage (22.4 mg vs 24.2 mg in morphine equivalents, p 1⁄4 0.89); this measurement did not take into account the eight OSP patients who required a PCA while none required the use of one in the RASP group. EBL was less in the RASP group but did not reach significance (290 mL vs 538 mL, p 1⁄4 0.12) as well as decrease in postoperative hemoglobin (1.13 vs 1.69, p 1⁄4 0.07). Operative time was significantly longer for the robotic group (200.6 mins vs 130.7 mins, p <0.01) although four of the RASP cases included additional procedures in addition to prostatectomy (cystolithotomy in three and bladder diverticulectomy in one). Foley duration was comparable (8.7 days vs 9.5 days, p 1⁄4 0.54). There was a larger decrease between preand post-operative IPSS in the OSP group (16.1 vs 12) from longer followup (16.9 months vs 5.4 months, p 1⁄4 0.10). There were three complications in the OSP group (highest Clavien grade 3) compared to four postoperative complications in the RASP group (highest Clavien grade 4). CONCLUSIONS: To date, our analysis is the first and only matched comparison between open and robotic-assisted simple prostatectomy for BPH. Between two similar cohort groups, we confirmed the significant benefits of shorter hospital stay and decreased narcotic intake in patients who underwent RASP with similar surgical outcomes.