Robot-assisted laparoscopic radical prostatectomy: report of 107 cases

Abstract

Objective To summarize our initial experience and early postoperative follow-up results with robot assisted laparoscopic radical prostatectomy (RALP) and evaluate the efficacy and safety of this surgical method.Methods 107 patients underwent RALP in our hospital from March 2012 to November 2013.The mean age of the patients was 67 years (range,49-80 years),The mean pretreatment serum PSA level was 23.6 μg/L(range,3.6-209.0 μg/L),and mean preoperative Gleason score was 7.4 (range,5-10).Clinical stages were between T1aN0M0-T3aN0M0,which ≤＜ T3c in 6 cases,T2a in 10 cases,T2b in 46 patients,T2c in 39 cases,T3a in 6 cases.Under the general anesthesia,all patients received RALP.Among them,transperitoneal approach was chosen in 102 patients and extraperitoneal approach was chosen in 5 patients.The level of serum PSA and urinary continence were followed up after procedure.Results Except one patient converted to open surgery due to the serious adhesion between prostate and rectum,the remaining 106 cases are performed successfully.The mean preoperative set up time of the robot was 52 min (range,28-106 min),and mean operation time was 182 min (range,118-462 min).The perioperative blood loss averaged 232 ml (range,50～ 1 300 ml),and 5 patients required blood transfusion ; The patients were ambulant between the 2nd and 4th postoperative days.Foley catheter was successfully removed on day 7 to 14 and mean hospital stay after surgery was 11 days (range,5-20 d).Postoperative pathology was prostatic adenocarcinoma in all patients.Pathological stages were between pT2aN0M0-pT3b N1 M0.Positive margin rate was 15％ (16/107).Seminal vesicle invasion was found in 7 patients and obturator lymph node metastasis was observed in 2 patients.The mean postperative Gleason score was 7.4 (range,6-10).During a median follow-up of 6 (range,1-19) months,the level of serum PSA was more than 0.2 μg/L in 9 patients 4 weeks after RALP.After 3 and 6 months,the urinary continence recovery rates were 87％ (71/82) and 92％ (36/ 39),respectively.Conclusions RALP showed significantly advantages,such as low perioperative blood loss,short hospital stay and fast continence recovery.Therefore,RALP is a feasible and safe technique for patients with localized prostate cancer. Key words: Robotics; Laparoscopes; Prostatic neoplasms; Prostatectomy