Assisted Radical Prostatectomy Research Articles

A novel method of bladder neck fixation during robot-assisted radical prostatectomy

Background. Appearance of new surgical techniques are aimed to improve not only oncological, but also functional outcomes of radical prostatectomy. A good urinary continence after radical surgical treatment remains an important aspect with not only medical but also social significance, since it can significantly reduce the patient’s quality of life.Aim. To describe a new surgical technique of lateral fixation of the bladder neck using autotissue during robotic- assisted radical prostatectomy, to evaluate its effecacy and safety.Materials and methods. From February till November 2020, 20 patients with localized prostate cancer underwent radical robot-assisted prostatectomy. All operations were performed in one medical center, by one experienced robotic surgeon (more than 1000 operations). After the imposition of vesicourethral anastomosis the reconstruction of pelvis was performed by lateral fixation of the vesical cervix with auto-tissue flaps of the intrapelvic fascia. A prerequisite was the preservation of the puboprostatic ligaments, endopelvic fascia and puboperineal muscles. The duration of the operation (console time and time of reconstruction), the volume of intraoperative blood loss, perioperative complications according to Clavien–Dindo, the duration of urethral catheter and the patient’s length of hospital stay, oncological results (pT stage, presence/absence of a surgical margin), the presence of immediate continence, as well as continence 3 months postoperatively were assessed.Results. The mean operative time was 142 (115–168) minutes, mean console time – 64 (50–98) minutes. The mean duration of lateral fixation stage was 3,5 (2–5,5) minutes. Urethral catheter was removed at 7th day postoperatively. There were no Clavien–Dindo group III–V complications registered. Immediate continence rate – 75 % (15 patients), early continence rate – 25 % (5 patients).Conclusion. The use of a new technique of lateral reconstruction during robotic-assisted radical prostatectomy using endopelvic fascia flaps is safe and effective, it improves functional outcomes without affecting oncological results.

A1151 - Surgical, oncological and functional outcomes following robotic- assisted radical prostatectomy using the SynchroSeal™ advanced diathermy instrument

A1151 - Surgical, oncological and functional outcomes following robotic- assisted radical prostatectomy using the SynchroSeal™ advanced diathermy instrument

Impact of protruded median lobe on perioperative, urinary continence and oncological outcomes of Retzius-sparing robot-assisted radical prostatectomy.

BackgroundTo investigate the effect of protruded median lobe (PML) on the perioperative, oncological, and urinary continence (UC) outcomes among patients underwent Retzius-sparing robot-assisted radical prostatectomy (RS-RARP).Methods231 consecutive patients who had undergone RS-RARP were collected and analyzed. Patients were divided into three groups based on the PML degree: PML<5 mm (n=99); 5≤ PML <10 mm (n=91); PML ≥10 mm (n=41). The perioperative outcomes, short-term oncological, and UC outcomes were compared among the three groups. Those outcomes were also compared in patients with significant PML (>10 mm) who underwent the traditional or Retzius-sparing RARP.ResultsThe median PML was significantly associated age (P<0.001) and prostate volume (P<0.001). Perioperative characteristics including console time, estimated blood loss (EBL), intraoperative transfusion rate, and complications were not statistically different among the three groups (P=0.647, 0.574, 0.231, 0.661, respectively). The rate of positive surgical margin (PSM) were not significantly different in the three groups (P=0.065). No significant difference regarding UC and biochemical recurrence (BCR) at 12-month follow-up was observed in the three groups (P>0.05). Comparison between the two approaches in men with significant PML showed better recovery of UC (HR =1.83, 95% CI: 1.117–3.01, log-rank P=0.002) and similar BCR (log-rank P=0.072) after RS-RARP.ConclusionsRS-RARP is an oncologically and functionally equivalent approach for patients with PML. Compared with the traditional approach, RS-RARP offers benefits regarding UC for cases with significant PML.

The Role of Multiparametric Magnetic Resonance Imaging to Detect the Extracapsular Extension in Robot- Assisted Radical Prostatectomy

The Role of Multiparametric Magnetic Resonance Imaging to Detect the Extracapsular Extension in Robot- Assisted Radical Prostatectomy

Impact of Diabetes Mellitus on Urinary Continence Recovery after Radical Prostatectomy: a Systematic Review and Meta-Analysis.

To evaluate the impact of diabetes mellitus (DM) on the recovery of urinary continence (UC) after radical prostatectomy (RP). A systematic review of English articles was performed in August 2019, following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. Trials were identified in a literature search of PubMed, Embase, Cochrane Library and Web of Science using appropriate search terms. All comparative studies reporting diabetes mellitus, study characteristics, and outcome data including the relationship between diabetes mellitus and urinary continence data were included. Continence rates at different time after RP were compared. Odds ratio (OR) was used for the comparison and all the results were presented with 95% confidence intervals (CIs). Seven cohort studies comprising with 5944 participants were included, the percentage of DM patients was 8.7%. The results showed that DM decreased urinary continence rates at 12 months after RP (OR 0.54, 95%CI 0.36 to 0.81, p = 0.003). The continence rates were not significantly different between DM and Non-DM groups at short-term (catheter removal, 3 months, 6 months) and long-term (>12 months). When stratified by the surgical approaches, the pooled results in patients who underwent robot -assisted radical prostatectomy (RARP) were similar to results of the overall analysis. DM has an adverse impact on the recovery of UC during the intermediate-term after RP. Well-designed trials with strict control of confounders are needed to make results more comparable.

Retzius-sparing robotic-assisted laparoscopic radical prostatectomy: Racial considerations for 250 consecutive cases.

e17546 Background: To report the functional and oncologic outcomes of a cohort of 250 consecutive prostate cancer patients undergoing a Retzius-sparing approach and to assess for racial differences in continence outcomes. Methods: This was a prospective, single-center, case series of 250 consecutive prostate cancer patients who underwent a Retzius-sparing robotic assisted laparoscopic radical prostatectomy by a single surgeon between May 2015 and April 2019.Our primary objective was to describe post-operative continence outcomes of patients undergoing this technique. Results: Median follow up was 24.0 months [Interquartile range (IQR) 18.0-30.0 months]. Median age and body mass index were 62.0 years (IQR 57.0-67.0) and 29.0 kg/m 2 (IQR 26.0-33.0), respectively. Median PSA was 8.22 ng/ml (IQR 5.74-13.31). 84.8% of patients were intermediate or high-risk pre-operatively. 96.0% had Gleason Score 7 or worse disease on final pathologic analysis. Positive margin incidence was 18.1% and 44.4% in patients with pT2 and pT3 disease, respectively. Immediate continence (i.e. continence achieved within one moth post-operatively) was achieved in 45.0% of patients. One-year continence rate was 92.0%. Caucasian patients experienced earlier return of continence (77% versus 65% at 3 months) compared to African American patients. IPSS scores gradually improved from 8.0 pre-operatively to 4.0 one year later. Median PSA level was 0.01 ng/ml (IQR 0.01-9.01) post-operatively. Conclusions: Retzius-sparing robotic assisted laparoscopic radical prostatectomy is an oncologically safe surgical technique with excellent short and long-term continence outcomes.

Curative effects of anatomic reconstruction of periurethral structure in robotic assisted laparoscopic radical prostatectomy

Objective To investigate the outcome of patients underwent anatomic periurethral reconstruction during robotic assisted laparoscopic radical prostatectomy (RARP). Methods During August 2016 to May 2018, anatomic periurethral reconstruction was performed during RARP in 58 consecutive patients. The control group consists of another 50 patients had no anatomic periurethral reconstruction procedure during RARP.Perioperative data of these patients were collected retrospectively, including operation time, anastomosis timeintraoperative blood loss, duration of indwelling catheter, length of hospital stay, complications, postoperative pathology, and continence outcome at 1, 3, 6, 12 months after surgery. Results All cases were successfully performed without conversion to open or laparoscopic surgery. There were no major intraoperative or postoperative complications. Operative time and anastomosis time was (145.3±12.3)mins and (31.6±8.2)mins in reconstruction group comparing to (122.4±11.4)mins and (21.2±4.4) in control group (both P 0.05). Postoperative pathology confirmed 53 T2a-T2b diseases and 5 pT2c diseases in reconstruction group, in comparison with 46 T2a-T2b and 4 pT2c diseases in non-reconstruction group (P>0.05). There were 19 and 15 cases with a final Gleason score of 6, 30 and 27 cases with Gleason 7, 9 and 10 cases with Gleason 8, in reconstruction group and non-reconstruction group respectively(all P>0.05). There was no significant difference between the two groups regarding incidence of positive surgical margins (3 in reconstruction group and 2 in control group, P>0.05). The percentage of patients maintain continence in reconstruction group and non-reconstruction group: at 1 month [84.5%(49/58)and 70.0%(35/50)], at 3 months [89.7%(52/58)and 78.0%(39/50)], at 6 months [91.3%(53/58)and 86.0%(43/50)] and 1 year after surgery [100.0%(58/58)and 96.0%(48/50)]. Reconstruction group showed better continence outcome at 1 and 3 month (P 0.05). Conclusion Anatomic reconstruction of periurethral structure during RARP is safe and feasible with reduced duration of indwelling catheter and better continence outcome. Key words: Robotic assisted laparoscopic surgery; Radical prostatectomy; Incontinence; Enhanced recovery after surgery

A clinical study of lung function protection in patients with robot assisted laparoscopic radical prostatectomy

Objective To evaluate the effect of manipulative pulmonary protective strategy on the pulmonary function of the patients undergoing robotic assisted laparoscopic radical prostatectomy under multiple-mode monitoring. Methods One hundred and twenty patients who underwent robot-assisted laparoscopic radical prostatectomy were divided into 4 groups (30 cases in each group) according to ASA Ⅰ-Ⅲ. Multimodal monitoring + manual relaxation group (group Mm), multimodal monitoring group (group M), conventional anesthesia + manual relaxation group (group m) and conventional anesthesia group (group C). In group Mm and group M, propofol was infused to achieve the BIS value of 45-55, then we monitored the muscle relaxation to conduct closed-loop infusion of cisatracurium. We also monitored and managed liquid input by vigileo. Group M and group C maintained peak airway pressure (≤30 cmH2O) (1 cmH2O=0.098 kPa) and PETCO2 35-40 mmHg (1 mmHg=0.133 kPa). Group Mm and group m received manual lung recruitment maneuver one times every 30 min after establishment of pneumoperitoneum until the end of operation. Blood gas analysis was performed before anesthesia induction (T1), 15 min after intubation (T2), 10 min after pneumoperitoneum (T3), 30 min after pneumoperitoneum (T4), 60 min after Trendelenburg (T5), 10 min after pneumoperitoneum cessation (T6), 5 min after extubation (T7). Airway peak pressure (Ppeak) and airway plateau pressure (Pplat) were recorded. The value of dynamic lung compliance (Cdyn), spiro-index (RI), dying cavity rate (VD/VT), oxygenation index (PaO2/FiO2) and alveolar arterial PO2 difference (A-aDO2) were calculated at different time points. Results Ppeak of group Mm and group m were more stable than Ppeak of group M and group C at T3 and T4 (P<0.05). Pplat of group Mm and group m were more stable than Pplat of group M and group C at T3 and T5 (P<0.05). Oxygenation indexes of group Mm and group m were higher than indexes of group M and group C at T5-T7 (P<0.05). A-aDO2 and RI were lower than group M and group C at T4, T5, T7 (P<0.05). At T4-T6, Cdyn was higher than Cdyn in group M and group C (P<0.05). Conclusions Manipulative pulmonary protective ventilation can improve the pulmonary function in patients undergoing robotic assisted laparoscopic radical prostatectomy under multimode monitoring. Key words: Robot; Therapeutic laparoscopy; Protective lung ventilation; Multi-mode monitoring; Prostate cancer

Improvement of continence with preservation of pelvic stabilized structure in patients undergoing robot-assisted laparoscopic radical prostatectomy

Objective To investigate the effect of pelvic floor stabilized structure preservation (PPSS) during robot-assisted laparoscopic radical prostatectomy (RARP) on postoperative continence recovery. Methods From October 2017 to April 2018, 86 patients with prostatic cancer who underwent traditional RARP and RARP plus PPSS were included. There were 31 patients in non-PPSS group and 55 patients in PPSS group. In non-PPSS group, patients age was (68.48±7.79) years old, BMI was (24.79±3.05) kg/m2, median prostate volume was 63.54 (53.00-99.36)cm3, clinic T-stage T1-T2, T3, T4 accounted for 49.39%, 22.58%, 6.45% and ISUP grade 1, 2, 3, 4, 5 accounted for 22.58%, 22.81%, 12.90%, 12.90%, 19.35% respectively. In PPSS group, patients age was (69.53±6.81) years old, BMI was (23.95±3.03) kg/m2, median prostate volume was 73.39 (54.88-94.23)cm3, clinic T-stage T1-T2, T3, T4 accounted for 72.73%, 7.27%, 3.64% and ISUP grade 1, 2, 3, 4, 5 accounted for 21.82%, 18.18%, 23.64%, 18.18%, 10.91% respectively. The preoperative PSA, BMI, clinical T-stage, ISUP grade, and postoperative hospital days had no significant differences(P>0.05) between the two groups.Both groups were operated via transperitoneal approach. In the non PPSS group, endo-pelvic fascia and pubic prostate ligament was cut, and dorsal vessel complex was ligated. In PPSS group, the partial endo-pelvic fascia was bluntly pushed to the pelvic wall to preserve tendon arch, and pubic prostate ligament also was preserved without suturing and ligating dorsal vascular complex. The catheter was removed 7 d after RARP. The continence recovery were compared between the two groups, including pad number on the day of 1, 7, 14, 30, 90 and ICI-Q-SF scores on the day of 30 and 90 after catheter removal. Results There was no significant difference in pad numbers used between the two groups on the day of 1, 7, 14, 30 after catheter removal. On the 90th day, the proportions of using pad ≥4 in PPSS group were significantly lower than those in non-PPSS group (1.89% vs. 20.69%, P=0.004). No significant difference was found in ICI-Q-SF scores on the 30th and 90th day between the two groups. Univariate analysis showed that PPSS group used less pads than non-PPSS group on the 90th day [OR=0.07(95%CI 0.01-0.65), P=0.019]; T3 patients used more pads than T1-T2 patients [OR=9.19(95%CI 1.32-63.87), P=0.025]. After adjusting for age, ISUP grading, T staging, and PSA, multivariate regression analysis showed that the risk of using pad ≥4 in PPSS group compared with non-PPSS group was 0.46, 0.34, 0.27, 0.25, and 0.03 on the day of 1 , 7, 14 , 30 and 90 after catheter removal, respectively. The PPSS approach didn′t increase the risk of positive surgical margin. Conclusions Preservation of pelvic stabilized structure in RARP is very efficient in term of continence rate after RARP, and it does not increase the risk of positive surgical margin. Key words: Prostatic neoplasms; Robotic assisted laparoscopic radical prostatectomy; Pelvic stabilized structure; Continence

The use of dehydrated human amnion/chorion membrane wrapping of the neurovascular bundle during robotic assisted laparoscopic radical prostatectomy: Intermediate term outcomes

The use of dehydrated human amnion/chorion membrane wrapping of the neurovascular bundle during robotic assisted laparoscopic radical prostatectomy: Intermediate term outcomes

The posterior approach of robot-assisted laparoscopic radical prostatectomy

Objective To explore the feasibility and safety of the posterior approach of robot-assisted laparoscopic radical prostatectomy and to the approach. Methods From November 2001 to April 2017, 32 patients underwent posterior approach of robot-assisted laparoscopic radical prostatectomy. Patients aged 53 to 81 years, with mean of 66.9 years old. Their prostate volumes were 12.0-73.7 ml with an average of 32.9 ml. All patients were diagnosed by prostate biopsy before surgery. The operation time, blood loss and length of hospital stay were recorded. Results All the operations were completed by robotic assisted laparoscopy with no transition to open surgery. The surgery time was 129-210 minutes with an average of 163.6 minutes. The estimated blood loss was 20-200 ml with an average of 59.3 ml. The hospital stay was 8-21 days with an average of 12.8 days. The postoperative hospital stay was 3-13 days with an average of 6.9 days. The time of postoperative catheter removal was 4-14 days with an average of 7.5 days. Postoperative follow-up was 1-6 months. Twenty-four (75%) patients had early recovery of continence, and all (100%) patients regained continence 3-month postoperatively. Conclusion The posterior approach of robotic assisted laparoscopic radical prostatectomy was a safe and effective surgical technique, which was beneficial in early continence recovery. Key words: Prostatic neoplasms; Robotic surgery; Radical prostatectomy; Posterior approach

V8-02 APPLICATION OF CHITOSAN MEMBRANES ON THE NEUROVASCULAR BUNDLES AFTER ROBOT-ASSISTED RADICAL PROSTATECTOMY: PRELIMINARY RESULTS OF A PHASE II STUDY

INTRODUCTION & OBJECTIVES: A physical damage can occur to the neurovascular bundles during the procedure, due to the use of cautery and tractions.Nowadays bio-engineeringis developing novel devices with the aim of co-operate the neural renewal. Among them chitosan seems to be promising with neuro-regenerative properties. In our Institution we tried to use chitosan membranes as scaffold for neural renewal after nervesparingrobot- assisted radical prostatectomy (RARP). In laboratory setting results were promising so we designed a prospectivestudytrying to confirmchitosanproperties in clinicalpractice. Primary end-point: to evaluate the feasibility of the application of chitosan membrane on neuro-vascular bundles after nerve-sparing RARP. Secondary end-point: To evaluate the recovery of erectile function at 1, 2, and 3 months postoperatively by performing a matched-pair analysis comparing the group of patients who underwent chitosan application to a control group who did not. MATERIAL & METHODS: 47patients who underwent nerve sparingRARP (07/2015 - 01/2016) were enrolled. Criteria for inclusion was an IIEF>17. A control group of patients was selected. Potency recovery was defined as erection enough for intercourse or masturbation. Membranes were adequately prepared by immersion in saline solution and cutting. After that reconstructive phase of RARP was performed, chitosan membranes were introduced and applied on the bundles. RESULTS: Baseline data of patients in the Groups were comparable.Concerning intraoperative data, no modifications of operative time was recorded in the Chitosan Group;No intraoperative complications occurred. Postoperative complications rate was not affected by the application of the membrane. Concerning the functional data, a faster erectile function recovery was recorded in the cohort of patients who underwent chitosan application. CONCLUSIONS: In our experience, the application of chitosan membranes on the neurovascular bundles after robot-assisted RP was easy and safe. Preliminary functional outcomes showed a faster recovery of erectile function in the cohort of patients who underwent the application of the membranes.Larger sample size and randomized trials are needed in order to confirm these preliminary outcomes.

PE50 - The application of chitosan membranes on the neurovascular bundles after robot-assisted radical prostatectomy: Preliminary results of a phase II study

INTRODUCTION & OBJECTIVES: A physical damage can occur to the neurovascular bundles during the procedure, due to the use of cautery and tractions.Nowadays bio-engineeringis developing novel devices with the aim of co-operate the neural renewal. Among them chitosan seems to be promising with neuro-regenerative properties. In our Institution we tried to use chitosan membranes as scaffold for neural renewal after nervesparingrobot- assisted radical prostatectomy (RARP). In laboratory setting results were promising so we designed a prospectivestudytrying to confirmchitosanproperties in clinicalpractice. Primary end-point: to evaluate the feasibility of the application of chitosan membrane on neuro-vascular bundles after nerve-sparing RARP. Secondary end-point: To evaluate the recovery of erectile function at 1, 2, and 3 months postoperatively by performing a matched-pair analysis comparing the group of patients who underwent chitosan application to a control group who did not. MATERIAL & METHODS: 47patients who underwent nerve sparingRARP (07/2015 - 01/2016) were enrolled. Criteria for inclusion was an IIEF>17. A control group of patients was selected. Potency recovery was defined as erection enough for intercourse or masturbation. Membranes were adequately prepared by immersion in saline solution and cutting. After that reconstructive phase of RARP was performed, chitosan membranes were introduced and applied on the bundles. RESULTS: Baseline data of patients in the Groups were comparable.Concerning intraoperative data, no modifications of operative time was recorded in the Chitosan Group;No intraoperative complications occurred. Postoperative complications rate was not affected by the application of the membrane. Concerning the functional data, a faster erectile function recovery was recorded in the cohort of patients who underwent chitosan application. CONCLUSIONS: In our experience, the application of chitosan membranes on the neurovascular bundles after robot-assisted RP was easy and safe. Preliminary functional outcomes showed a faster recovery of erectile function in the cohort of patients who underwent the application of the membranes.Larger sample size and randomized trials are needed in order to confirm these preliminary outcomes.

Standardized procedure of robotic assisted laparoscopic radical prostatectomy from case 1 to case 1200

Standardized procedure of robotic assisted laparoscopic radical prostatectomy from case 1 to case 1200

664 Robot assisted laparoscopic radical prostatectomy: An old but new method to draw learning curves

664 Robot assisted laparoscopic radical prostatectomy: An old but new method to draw learning curves

Impact of Intravesical Prostatic Protrusion on Continence Outcomes after Robotic-Assisted Laparoscopic Radical Prostatectomy

Purpose: We try to evaluate the influence of intravesical prostatic protrusion (IPP) in the postoperative continence of patient who received robotic assisted laparoscopic radical prostatectomy. Methods: A total 600 patients who underwent robotic assisted laparoscopic radical prostatectomy were included in the study. Preoperative MRI was performed in all patients and the vertical distance from the tip of the protruding prostate to the base of the urinary bladder was measured in all sagittal plane. The degree of intravesical prostatic protrusion were divided into three groups (IPP<5 mm, 5 mm<IPP<10 mm, 10 mm<IPP). Surgical procedure was mentioned. Continence was defined as no pad use or only one safety pad per day and assessed at 1, 3 and 12 months postoperatively. The result was examined. Results: The overall continence rate at 1, 3 and 12 month was 69.2%, 91.33% and 95.5%. Among the three groups, there is significant difference in 1 month, 3 months and 12 months continence rate (IPP<5 mm: 82.5%, 96.3%, 97.7%; 5 mm<IPP<10 mm: 61.9%, 89.4%, 94.4%; 10 mm<IPP: 30%, 75.6%, 88.9%, p<0.001). At first month, 415 patients achieved continence but 195 patients still incontinence and the length of IPP among the two groups were 4.43 mm ± 3.74 mm and 8.69 mm ± 6.63 mm, p<0.001. There is also significant difference in IPP length among continence and incontinence group. Conclusions: To our result, both of intravesical prostatic protrusion and prostate volume was correlated with recovery of early and one year continence after robotic assisted laparoscopic radical prostatectomy and with inferior outcome.

Prevention and management of complications during robotic assisted laparoscopic radical prostatectomy from comprehensive planning : Experience of a single surgeon of 1000 cases

Prevention and management of complications during robotic assisted laparoscopic radical prostatectomy from comprehensive planning : Experience of a single surgeon of 1000 cases

Comparative study on the efficacy and safety of robot assisted laparoscopic and retropubic radical prostatectomy

Objective To compare the efficacy and safety of robot assisted laparoscopic radical prostatectomy (RALRP) and retropubic radical prostatectomy (RRP). Methods From May 2004 to September 2013, data from 124 prostate cancer patients were collected. Of them, 41 cases underwent RALRP, and 83 cases underwent RRP. The following clinical data was reviewed and analyzed, including operation time, blood loss, transfusion rate, duration of catheterization, time of postoperative hospital stay, postoperative pathology, continence and biochemical recurrence. Results All the operations were successfully performed, without RALRP converted to open surgery. The mean operation time of the RALRP group and the RRP group was 224 min and 165 min, mean blood loss was 266 ml and 659 ml, the transfusion rates were 20% and 86%, the mean postoperative hospital stay was 16.4 d and 17.9 d, the positive margin rates were 24% and 10%, the differences were significant (P 0.05). The 6–month, 1–year and 2–year biochemical recurrence rates were 8%, 21% and 24% in RALRP group, and 13%, 16%, 31% in RRP group. The 3–month, 6–month, 1–year and 2–year continence rates were 56%, 70%, 80% and 94% in RALRP group, and 55%, 70%, 78% and 79% in RRP group. For biochemical recurrence and continence rates, there was no significant difference between the 2 groups. Conclusions RALRP possesses advantages of less bleeding and faster recovery. In addition, the effect of postoperative oncology and continence is similar to open surgery. Key words: Prostatic neoplasms; Robots; Retropubic; Biochemical recurrence; Continence

Application and advantages of robot–assisted laparoscopic surgery in the treatment of high–risk prostate cancer

Objective To evaluate the feasibility and advantages of robot–assisted laparoscopic radical prostatectomy (RALRP) in treating high–risk prostate cancer. Methods From Mar.2010 to Dec.2014, 69 men with high–risk prostate cancer (clinical stage ≥T3a, serum PSA ≥20 μg/L or biopsy Gleason score ≥8) underwent surgical treatment at our center.RALRP was performed in 44 cases, with a mean age of (66.7±8.6) yrs (range: 50~82) and a mean baseline PSA of (23.1±11.2)μg/L (range: 3.6–48.8). Transperitoneal approach was adopted in all cases.Twenty–five patients were treated with ORP.The mean age was (64.3±5.9)yrs (range: 52–75) and baseline PSA was (21.7±10.2)μg/L (range: 5.7–41.3). Baseline clinical features, including age, initial PSA, biopsy Gleason score and clinical staging, were comparable between two cohorts.Surgical outcomes after RALRP were analyzed and compared between groups. Results All RALRP procedures were successfully performed with da Vinci robotic system and there was no open conversion.Mean operation duration were similarly (158±47)min for RALRP group and (152±42)min for ORP group, respectively.The mean estimated blood loss and postoperative length of hospital stay in RALRP group were (328±254)ml and (8.4±3.1)days, both of which were significant lower than those in ORP group, (674±302)ml and (14.4± 3.7)days.Two cases of urine leak and two of lymphatic leak occurred after RALRP, and a statistically insignificantly higher complication rate was observed for the ORP group, in which four of urine leak and three of lymphatic leak happened.The positive surgical margin rates of two groups were 20.5% and 24%, respectively.After the mean follow–up of 25 (RALRP) and 27 months (ORP), continence rate was significantly higher in the RARLP group (93.2% vs.72.0%). PSA failure was observed in seven RALRP cases (15.9%) and four ORP cases (16.0%). Conclusion Compared with traditional ORP, RALRP shows significant advantages, including less blood loss, fewer complications, shorter length of stay, better postoperative continence and equivalent oncologic outcome when dealing with high–risk prostate cancer cases.Robot–assisted surgery is a safe and efficacious surgical modality in this setting. Key words: Robot; Prostate neoplasms; Prostatectomy; High–risk

Robotic-assisted laparoscopic partial nephrectomy for small renal cell carcinoma: Chi Mei Medical Center experience

Robotic-assisted laparoscopic partial nephrectomy for small renal cell carcinoma: Chi Mei Medical Center experience