Robotic Radical Prostatectomy Research Articles

From an On-site Program to a Mobile App for Prehabilitation and Rehabilitation for Robotic Radical Prostatectomy: Lessons Learned from 5 Years of Experience, the COVID-19 Outbreak, and Comparison with Nationwide Data

Prehabilitation programs play a key role in optimizing patient experiences and outcomes after surgery. However, there are few data on robot-assisted radical prostatectomy, and prehabilitation programs may be challenging to launch and maintain over time for every patient. Here we report our 5-yr experience of an on-site prehabilitation program and its impact on patient and hospital outcomes. During the study period, we observed continuous improvements in the same-day discharge rate (from 0% to 26.4%), hospital stay (from 3 to 0.9. d), costs (-63%), days out of hospital within 30 d after surgery in our center, and in comparison to contemporary nationwide data. However, despite these advantages, maintenance and diffusion of this program could be challenging owing to the absence of incentive support and lack of human resources. This led us to develop two free-access mobile apps, available on the app stores for both patients and surgeons, that include checklists, remote monitoring, and multiple educational materials aimed at simplifying the widespread use of optimized perioperative pathways. Patient summaryWe found that a prehabilitation program before surgery can help in optimizing patient outcomes after robot-assisted removal of the prostate. We translated this program into a mobile app available for every patient.

Analysis of the learning curve for Retzius-sparing robot-assisted radical prostatectomy for a single surgeon

Background: The learning curve for Retzius-sparing robotic radical prostatectomy is not fully understood. Objective: This study attempts to identify the learning curve across the first 130 cases of a single surgeon. Design, Setting and Participants: All Retzius-sparing robotic radical prostatectomy cases performed by a single surgeon at a high-volume tertiary hospital between April 2019 and July 2022 were included. Outcome Measurements and Statistical Analysis: Outcome measures included positive surgical margin rate, complication rates and unplanned readmission to hospital, postoperative urinary continence, erectile function and prostate-specific antigen (PSA) measurement. Cases were divided chronologically into three groups and differences between groups assessed. Results and Limitation: A total of 130 Retzius-sparing robot-assisted radical prostatectomy (RS-RARP) cases were identified. Differences were found between groups in several areas. Positive surgical margin rate fell between Group 1 (30.2%) and Group 3 (9.1%). Safety, postoperative continence, erectile function and PSA remained stable. Median patient age increased between Group 1 (59 years) and Group 3 (66.5 years) ( p = 0.04). Proportion of patients with stage >T2 increased between Group 1 (27.9%) and Group 2 (41.9%) ( p = 0.036). Median console time increased between Group 1 (120 minutes) and Group 2 (150 minutes) ( p = 0.01). Median gland weight increased between Group 1 (28 g) and Group 3 (35.5 g) ( p < 0.001). Conclusions: The positive surgical margin rate improved over the learning curve, despite the complexity of cases increasing, reflected in older patients, larger prostates and higher stage disease. Safety and functional outcomes are excellent throughout. The learning curve might be facilitated by careful case selection favouring smaller prostates with less advanced disease. Patient Summary: We analysed the learning curve for Retzius-sparing robotic radical prostatectomy. Across the first 130 cases, positive surgical margin rate fell; safety and continence remained excellent. Selection of smaller and less advanced cases may facilitate learning. Level of evidence: III

Intraoperative Frozen Section via Neurosafe During Robotic Radical Prostatectomy in the Era of Preoperative Risk Stratifications and Primary Staging With mpMRI and PSMA-PET CT: Is There a Perfect Candidate?

We aimed to analyze the effect of preoperative risk assessment including Ga-68 PSMA PET and multiparametric magnetic resonance imaging (mpMRI) on nerve sparing practices, positive surgical margin (PSM) rates and oncological outcomes based on a comparison between patients underwent RARP with and without Neurosafe (NS). Patients underwent RARP with NS (RARP-NS) or without (RARP-only) NS retrospectively evaluated. Suspicion for extracapsular extension on mpMRI and/or Ga-68 PSMA PET was recorded as i(imaging)T3. NS was performed according to the Martini-Klinik technique. PSM at preserved bundle side were called PSM at region of interest (ROI) while the others were elsewhere. A total of 208 patients (90 in RARP-NS, 118 in RARP-only groups) were included. Preoperatively the RARP-only group showed significantly higher mean PSA (p=.01) and PIRADS 5 (p=.002) findings and had more D'Amico high risk (DAHR) patients (p=.08). The overall PSM rates for pT2 versus pT3 disease were 7.5% versus 21.6 and 15.6% versus 55% in RARP-NS and RARP-only groups, respectively. NS resulted in more bilaterally preserved bundles (81.1% vs. 66.3%) and less PSM at the ROI (3.3% vs. 23.4%) than RARP-only group. NS outperformed RARP-only in all clinical settings had its highest differential benefit in more bilateral nerve sparing and less PSM at ROI in patients with both DAHR and iT3 disease. BCR rates were 2.2% and 2.5% for RARP-NS and RARP only groups, respectively (p=.4). One patient in RARP-NS and 9 in RARP-only groups had PSA persistence (p=.02). RARP-NS led to more preserved bundles with less PSM. It was especially useful in DAHR patients with preoperative extracapsular extension suspicion in imaging simultaneously.

Patient’s safety and satisfaction on same day discharge after robotic and laparoscopic radical prostatectomy versus discharge after 24 or 48 h: a longitudinal randomized prospective study

BackgroundThere is a tendency of prompted global health systems to reduce the length of hospital stay without compromising patient safety or satisfaction. We evaluated the safety and viability of early discharge in patients undergoing minimally invasive radical prostatectomy (MIRP), as well as patient satisfaction with this strategy.MethodsThis longitudinal prospective study included 72 patients who underwent MIRP for prostate cancer. Three groups were performed according to the day of hospital discharge following surgery: same day (G1), first day after (G2), and second day after (G3). Satisfaction, adverse events, and readmission were analyzed for each group. Associations between clinicopathologic variables and same-day discharge were analyzed by comparing data between G1 patients who did and did not achieve same-day discharge.Results16.7% of patients were not discharged according to randomization (10 randomized to G1). 80% of G1 patients who did not achieve same-day discharge had Gleason scores of 3 + 4 or 4 + 3, which were observed in 35.7% of patients discharged on the same day (P < 0.05). Average prostate weight was significantly lower in patients who achieved same-day discharge than in those who did not (P < 0.01). Univariable logistic regression points to Gleason scores of 3 + 4 or 4 + 3 as the main factors associated with unsuccessful same-day discharge (P < 0.05). There were no significant differences in satisfaction scores.ConclusionsSame-day discharge was both safe and feasible and does not appear to affect satisfaction in a subset of patients with prostate cancer. Surgeons should consider the Gleason score when determining whether same-day discharge is appropriate.

Extraperitoneal robot-assisted radical prostatectomy with the Hugo™ RAS system: initial experience of a tertiary center with a high background in extraperitoneal laparoscopy surgery.

The Hugo™ RAS system is a novel robotic platform with innovative features. However, there are currently no available data on extraperitoneal robot-assisted radical prostatectomy (RARP) performed using this system. The objective of this study is to describe the surgical setup and assess the safety and feasibility of the extraperitoneal approach in robotic radical prostatectomy with the Hugo™ RAS system. Sixteen consecutive patients diagnosed with localized prostate cancer underwent extraperitoneal RARP ± lymph node dissection at our institution, between March and May 2023. All RARP procedures were performed extraperitoneal with a modular four-arm configuration. The focus was to describe the operative room setup, trocar placement, tilt and docking angles and evaluate the safety and feasibility of this approach with this robotic platform. Secondary outcomes recorded included, total operative time, console time, estimated bleeding, intra- and postoperative complications, and length of stay after surgery. A descriptive analysis was conducted. We report on the first sixteen cases of extraperitoneal robot-assisted radical prostatectomy performed with the new Hugo™ RAS system. All procedures were completed, without the need for conversion or placement of additional ports. No intraoperative complications or major technical failures that would prevent the completion of surgery were recorded. The median operative time was 211min (IQR 180-277), and the median console time was 152min (IQR 119-196). The mean docking time was 4.6min (IQR 4.1-5.2). The median estimated blood loss and the median time to remove the vesical catheter were 200mL (IQR 150-400) and 8days (IQR 7-8), respectively. The median length of stay was 2 days (IQR 2-2). Only one minor complication was registered in the first 30days. This study provides evidence of the safety and feasibility of the extraperitoneal approach in RARP with the Hugo™ RAS system. The description of the surgical setup in terms of trocar placement, arm-cart disposition, tilt and docking angles offers valuable information for surgeons interested in adopting this surgical approach with the Hugo™ RAS platform.

The role of PSMA PET/CT to predict upgrading in patients undergoing radical prostatectomy for ISUP grade group 1 prostate cancer.

To investigate the additive role of prostate-specific membrane antigen (PSMA) positron emission tomography/computed tomography (PET/CT) independent from multiparametric magnetic resonance imaging (mpMRI) and clinical-pathological parameters to predict pathological upgrading in patients with ISUP grade group (GG) 1 prostate cancer (PCa) at prostate biopsy. A total of 41 patients who underwent robotic radical prostatectomy (RP) for GG1 disease at prostate biopsy with preoperative PSMA PET/CT and mpMRI images available for central review were included in the study. Univariate and multivariate logistic regression analyses were performed to determine the independent predictors of pathological upgrading (GG ≥ 2). Final RP pathology revealed upgrading in 26 patients (65.9%); to GG 2 disease in 25 cases and GG 4 disease in one case. International Society of Urological Pathology (ISUP) upgrading rates for prostate imaging-reporting and data system (PIRADS)-5, PIRADS-4, and PIRADS ≤ 3 lesions were 78%, 74%, and 38%, respectively. Fourteen out of 15 (93.3%) patients with an SUVmax ≥ 5.6 and all patients with an SUVmax ≥ 6.5 (n = 10) had pathological upgrading. The upgrading rate in patients with SUV < 5.6 was 46.2% (12/26). Intraprostatic SUVmax ≥ 5.6 was found as the only independent predictor of pathological upgrading in multivariate analysis. High prostatic PSMA uptake was found to be a very reliable predictor of pathological upgrading, but low PSMA uptake cannot exclude pathological upgrading. Intraprostatic PSMA uptake along with previously known mpMRI and biopsy-related parameters should be considered when making a treatment decision in patients with GG1 PCa at prostate biopsy.

Comparison of senhance and da vinci robotic radical prostatectomy: short-term outcomes, learning curve, and cost analysis.

The Senhance® Robotic System is a new laparoscopy-based platform that has been increasingly used in radical prostatectomy (RP) procedures. The purpose of this study is to compare the outcome of Senhance RP (SRP) with da Vinci RP (DRP) cases. From August 2019 to April 2022, we prospectively recruited 63 cases of SRP. We compared the perioperative data, postoperative complication rates, short-term surgical outcomes (3-month postoperative undetectable prostate-specific antigen (PSA) and incontinence rates), learning curves, and cost analysis with data from 63 matched da Vinci Xi RP cases. There was no difference in BL (180 versus 180 ml, p = 0.86) and postoperative surgical complication rate (Clavient -Dindo grade I-IV, 25.3 versus 22.2%, p = 0.21) between the SRP cases and the DRP. Regarding the oncologic and continence function, there was no difference between positive margin rate (36.5% versus 41.3%, p = 0.58), rate of undetectable PSA level at postoperative 3 months (68.3 versus 66.7%, p = 0.85), and incontinence rate (14.3 versus 15.9%, p = 1.0) at postoperative 3 months between the two cohorts. The learning curve showed a quick downward slope for laparoscopic experienced surgeons. The median pocket cost for SRP patients in our hospital was $4170, which was lower than $7675 for the DRP patients. Safety and short-term outcomes are comparable between SRP and DRP. For experienced LRP surgeons, using the Senhance system to perform RP is straightforward. With a more affordable price as its biggest advantage, the Senhance system may serve as a safe and effective alternative for robotic RP.

Video 16 - Robotic radical prostatectomy in massive prostatomegaly: operative challenges and technique adaptations

Video 16 - Robotic radical prostatectomy in massive prostatomegaly: operative challenges and technique adaptations

PJY06 - Enhanced postoperative recovery following robotic radical prostatectomy using a single-port regionalized approach

PJY06 - Enhanced postoperative recovery following robotic radical prostatectomy using a single-port regionalized approach

PE053 - Massive pre-prostatic tissue lymph node metastasis removed during robotic radical prostatectomy

PE053 - Massive pre-prostatic tissue lymph node metastasis removed during robotic radical prostatectomy

VE49 - Video comparison of HUGO-RAS vs. daVinci techniques in robotic radical prostatectomy: Providing insights from our preliminary study results

VE49 - Video comparison of HUGO-RAS vs. daVinci techniques in robotic radical prostatectomy: Providing insights from our preliminary study results

Clipless Athermal Suture-ligation of Pedicle and Antegrade Nerve-sparing (CASPAN) technique in Robotic Laparoscopic Radical Prostatectomy (RLRP)

Clipless Athermal Suture-ligation of Pedicle and Antegrade Nerve-sparing (CASPAN) technique in Robotic Laparoscopic Radical Prostatectomy (RLRP)

PE038 - Application of Cumulative SUM control charts (CUSUM) in the learning curve of robotic radical prostatectomy

PE038 - Application of Cumulative SUM control charts (CUSUM) in the learning curve of robotic radical prostatectomy

PE019 - Single-port transvesical robotic radical prostatectomy: Description of technique and perioperative outcomes of more than 200 patients

PE019 - Single-port transvesical robotic radical prostatectomy: Description of technique and perioperative outcomes of more than 200 patients

PE029 - Preliminary comparative study between the Hugo-RAS system and the daVinci system for the performance of robotic radical prostatectomy

PE029 - Preliminary comparative study between the Hugo-RAS system and the daVinci system for the performance of robotic radical prostatectomy

PE045 - Standard vs. augmented reality robotic radical prostatectomy: Proof of concept

PE045 - Standard vs. augmented reality robotic radical prostatectomy: Proof of concept

VE44 - A modified hood technique - continence preserving robotic radical prostatectomy

VE44 - A modified hood technique - continence preserving robotic radical prostatectomy

Initial experience of laparoendoscopic single-site radical prostatectomy with a novel purpose-built robotic system

ObjectiveThis prospective single-arm clinical trial aimed to evaluated the feasibility and safety of the application of the SHURUI system (Beijing Surgerii Technology Co., Ltd., Beijing, China), a novel purpose-built robotic system, in single-port robotic radical prostatectomy. MethodsSixteen patients diagnosed with prostate cancer were prospectively enrolled in and underwent robotic radical prostatectomy from October 2021 to August 2022 by the SHURUI single-port robotic surgical system. The demographic and baseline data, surgical, oncological, and functional outcomes as well as follow-up data were recorded. ResultsThe mean operative time was 226.3 (standard deviation [SD] 52.0) min, and the mean console time was 183.4 (SD 48.3) min, with the mean estimated blood loss of 116.3 (SD 90.0) mL. The mean length of postoperative hospital stay was 4.50 (SD 0.97) days. Two patients had postoperative complications (Clavien-Dindo Grade II), and both patients improved after conservative treatment. All patients’ postoperative prostate-specific antigen levels decreased to below 0.2 ng/mL 1 month after discharge. The mean prostate-specific antigen level further decreased to a mean of 0.0219 (SD 0.0641) ng/mL 6 months after surgery. Thirty days postoperatively, 12 out of 16 patients reported using no more than one urinary pad per day, and all patients reported satisfactory urinary control without the need for pads 6 months after surgery. ConclusionThe SHURUI system is safe and feasible in performing radical prostatectomy via both transperitoneal and extraperitoneal approaches. Tumor control and urinary continence were satisfying for patients enrolled in. The next phase involves conducting a large-scale, multicenter randomized controlled trial to thoroughly assess the effectiveness and safety of the new technology in a broader population.

The utility of the ChatGPT artificial intelligence tool for patient education and enquiry in robotic radical prostatectomy.

To assess the ChatGPT (Open AI) artificial intelligence platform's utility and accuracy as a patient education tool in robotic-assisted radical prostatectomy. The ChatGPT 3.5 interface ( https://chat.openai.com/chat ) was interrogated and asked the 14 questions related to the frequency of complications of robotic-assisted radical prostatectomy as listed on British Association of Urological Surgeons (BAUS) patient information leaflet "Robotic-Assisted Laparoscopic Radical Prostatectomy)" published July 2021. The AI's responses to each question were tabulated, and compared alongside the official figures quoted from the BAUS information leaflet. A global assessment of the AI's response was also made for accuracy and relevance to patients. Of the 14 questions asked, 11/14 (78.6%) of ChatGPT's quoted figures were considered concordant and comparable to those quoted by the BAUS patient information leaflet. 13/14 (92.9%) of ChatGPT's responses were globally assessed to contain accurate information, appropriate, and pertinent to a patient's potential enquiry. ChatGPT is a powerful tool and is able to generate accurate and helpful information for patients seeking information regarding urological procedures and their potential complications. It is not, however, infallible, and urologists should remain vigilant in their patient interactions to any potential misinformation a patient may have gathered from it in their personal research prior to surgery.

Radical Prostatectomy Technique Dispute: Analyzing Over 1.35 Million Surgeries in 20 Years of History.

Systematic reviews (SR) produce the best evidence comparing open (RRP), laparoscopic (LRP), and robotic (RARP) radical prostatectomy (RP). However, the hyperfiltration of evidence generates very specific scenarios that reduce the power of extrapolation. To compare RP evidence regarding demographics using a new methodology called reverse systematic review (RSR). Between 2000 and 2020, 8 databases were searched for SR studies on RRP, LRP, or RARP. All references were captured and analyzed over time in 80 SR. Total of 1724 reports (nr=752, 43.7% for RARP; nr=559, 32.4% for RRP; nr=413, 23.9% for LRP) described 1,353,485 patients (881,719, 65.1% RRP; 366,006, 27.0% RARP; 105,760, 7.8% LRP). Patients/center/year was higher in RARP compared to LRP and RRP, median 50.0, 40.0, and 36.66, respectively, P < .001. Surgeons per study was lesser in RARP and LRP compared to RRP, median 2.0, 2.0, and 6.0, respectively, P < .001. Study duration and follow-up in years was shorter in RARP compared to LRP and RRP, median 2.6, 3.0, and 4.0, respectively, P < .001. Cumulative RARP reports predominate in North America (55.7%, nr=468) and Asia (47.8%, nr =129), while LRP predominate in Europe (42.3%, nr =230) and RRP in Oceania (45.1%, nr=23). After 2010 all continents began to accumulate more patients in the robotic approach. Potential biases related to shorter follow-up, greater volume centers, and surgeons were identified favoring the RARP. Analyzing the context of the available evidence is essential to compare techniques. Influenced by economic and scientific interests, robotic surgery was developed in centers with a higher volume of surgeries, characterizing potential biases when comparing techniques in the clinical shared decision.