Abstract
PurposeOpen simple prostatectomy (OSP) is a standard surgical technique for patients with benign prostatic hyperplasia with prostate size larger than 80 ml. As a minimally invasive approach, robot-assisted simple prostatectomy (RASP) emerged as a feasible surgical alternative. Currently, there are no definite recommendations for the standard use of RASP. Therefore, we aimed at investigating various clinical outcomes comparing RASP with OSP.MethodsIn this retrospective single-center study, we evaluated clinical data from 103 RASP and 31 OSP patients. Both cohorts were compared regarding different clinical characteristics with and without propensity score matching. To detect independent predictive factors for clinical outcomes, multivariate logistic regression analysis was performed.ResultsRobot-assisted simple prostatectomy patients demonstrated a lower estimated blood loss and need for postoperative blood transfusions as well as less postoperative complications. OSP had a shorter operative time (125 min vs. 182 min) longer hospital stay (11 days vs. 9 days) and longer time to catheter removal (8 days vs. 6 days). In the multivariate analysis, RASP was identified as an independent predictor for longer operative time, lower estimated blood loss, shorter length of hospital stay, shorter time to catheter removal, less postoperative complications and blood transfusions.ConclusionRobot-assisted simple prostatectomy is a safe alternative to OSP with less perioperative and postoperative morbidity. Whether OSP (shorter operative time) or RASP (shorter length of hospital stay) has a more favorable economic impact depends on the particular conditions of different health care systems. Further prospective comparative research is warranted to define the value of RASP in the current surgical management of benign prostatic hyperplasia.
Highlights
Besides endoscopic enucleation of the prostate, open simple prostatectomy (OSP) is the standard surgical treatment for men with moderate to severe lower urinary tract symptoms (LUTS) and a prostate size larger than 80 ml [1]
We focused on preoperative (ASA classification system [15], Charlson comorbidity index [16], prostate size [ml] measured by transrectal ultrasound, preoperative urinary retention, preoperative post void residual urine [ml]), intraoperative and postoperative variables
While intraoperative transfusion rates were comparable, estimated blood loss was significantly higher for OSP than for robot-assisted simple prostatectomy (RASP) (682 ml vs. 248 ml)
Summary
Besides endoscopic enucleation of the prostate, open simple prostatectomy (OSP) is the standard surgical treatment for men with moderate to severe lower urinary tract symptoms (LUTS) and a prostate size larger than 80 ml [1]. As a minimal invasive alternative to OSP, robot-assisted simple prostatectomy (RASP) was first described by Sotelo et al in 2008 [4]. Efficacy and safety of RASP have been investigated in different noncomparative studies and a multinational analysis.[8, 9]. There is a paucity of research comparing RASP with OSP. Hoy et al retrospectively reviewed 4 RASP patients and 28 OSP patients [10]. In a larger retrospective study, propensity score-matched cohorts of 59 OSP patients and 59 RASP patients were compared [11]. In the only prospective comparative trial available, Mourmouris et al compared 15 OSP patients and 26 RASP patients in a non-randomized multi-center study [12]. We aimed to investigate the association between OSP vs RASP by analyzing clinical perioperative and postoperative outcome characteristics. As cost effectiveness has become more and more important, we addressed variables with economic impact such as length of hospital stay and operative time
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