Robot-assisted Laparoscopic Radical Prostatectomy: Clinical Experience of 200 Cases

Sung Yul Park; Won Sik Ham; Young Deuk Choi; Koon Ho Rha

doi:10.4111/kju.2008.49.3.215

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Park, Ham, Choi, and Rha: Robot-assisted Laparoscopic Radical Prostatectomy: Clinical Experience of 200 Cases

Original Article

Korean J Urol 2008;49(3):215-220.

Published online: 17 January 2008

DOI: https://doi.org/10.4111/kju.2008.49.3.215

Robot-assisted Laparoscopic Radical Prostatectomy: Clinical Experience of 200 Cases

Sung Yul Park, Won Sik Ham, Young Deuk Choi, Koon Ho Rha

¹Department of Urology, Urological Science Institute and Brain Korea 21 Project for Medical Science, Yonsei University College of Medicine, Seoul, Korea

교신저자: 나군호 연세대학교 의과대학 비뇨기과학교실 서울시 서대문구 신촌동 134 120-752, TEL: 02-2228-2318, FAX: 02-312-2538, E-mail: khrha@yumc.yonsei.ac.kr

Revised 7 December 2007 Accepted 29 January 2008

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Purpose

We report the initial functional and surgical results of 200 robot-assisted laparoscopic radical prostatectomies performed at our hospital, and evaluate the efficacy and safety of this surgery.

Materials and Methods

Between July 2005 and July 2007, 200 patients underwent robot-assisted laparoscopic radical prostatectomy (RLRP). All cases were performed using the four-arm da Vinci^TM robot system (Intuitive Surgical, Mountain View, USA). RLRP was performed by two surgeons. All operations were approached transperitoneally. We studied the perioperative parameters and early surgical outcome retrospectively.

Results

The mean age at surgery was 64±8.2 years. The median preoperative prostate-specific antigen level was 8.24ng/ml (range, 1.37-726.60 ng/ml) and the mean preoperative Gleason score was 6.5 (range, 4-9). The median total operative time was 215 min (range, 140-418 min) and the median estimated blood loss was 300ml (range, 50-2,700ml). A positive surgical margin was found in 64 patients (32.0%). A normal diet was started 2.3 days after surgery and the median hospital stay was 5 days (range, 2-26 days). Among 71 patients with over 6 months followup, 69 patients (97.2%) were completely continent at 6 months after surgery and 29 patients (40.8%) were completely continent at catheter removal. In 58 patients who were younger than 65 years, potent preoperatively, and received a nerve sparing procedure, 31 patients (53.4%) were potent at 6 months after surgery.

Conclusions

We were able to verify the feasibility and safety of RLRP in the management of prostate cancer. A longer followup of the data and larger prospective studies are necessary to confirm these results.

Keywords: Robotics, Prostatectomy, Prostate neoplasms

REFERENCES

1. Guillonneau B, el-Fettouh H, Baumert H, Cathelineau X, Doublet JD, Fromont G, et al. Laparoscopic radical prostatectomy: oncological evaluation after 1,000 cases a montsouris institute. J Urol. 2003; 169:1261–6.

2. Hemal AK, Srinivas M, Charles AR. Ergonomic problems associated with laparoscopy. J Endourol. 2001; 15:499–503.

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6. Bentas W, Wolfram M, Jones J, Brautigam R, Kramer W, Binder J. Robotic technology and the translation of open radical prostatectomy to laparoscopy: the early Frankfurt experience with robotic radical prostatectomy and one year followup. Eur Urol. 2003; 44:175–81.

7. Menon M, Tewari A, Peabody JO, Shrivastava A, Kaul S, Bhandari A, et al. Vattikuti Institute prostatectomy, a technique of robotic radical prostatectomy for management of localized carcinoma of the prostate: experience of over 1100 cases. Urol Clin North Am. 2004; 31:701–17.

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Fig. 1.

Port placement for robot-assisted laparoscopic radical prostatectomy (six-port technique).

Fig. 2.

Dissection of the bladder neck.

Fig. 3.

Veil of Aphrodite technique.

Fig. 4.

Urethrovesical anastomosis.

Table 1.

Preoperative, operative, oncologic, and postoperative results

Variable
Mean age (year)	64.0±8.2
Mean BMI (kg/m²)	24.2±2.6
Median preoperative PSA (ng/ml)	8.24 (1.37-726.60)
Mean preoperative Geason score	6.5±1.0
Clinical stage (%)
≤T2	162/200 (81.0)
≥T3	38/200 (19.0)
Median operation time (min)	215 (140-418)
Median estimated blood loss (ml)	300 (50-2,700)
Intraoperative complications (%)	26/200 (13.0)
Rectal injury	6/200 (3.0)
Transfusion	19/200 (9.5)
Large bowel injury	1/200 (0.5)
Mean pathologic prostate volume (g)	32.1±15.1
Mean postoperative Gleason score	6.7±1.5
Positive surgical margins (%)
Total	64/200 (32.0)
≤T2	45/162 (27.8)
≥T3	19/38 (50.0)
Median hospital stay (day)	5 (2-26)

BMI: body mass index, PSA: prostate-specific antigen

Table 2.

Postoperative functional outcomes

Variable
Complete continence (%)
Total (6 months after operation)	69/71 (97.2)
Immediate (at catheter removal)	29/71 (40.8)
Potency (%)
≤65 year, preoperative potent
Erection	31/58 (53.4)
Masturbation/Coitus	20/58 (34.5)
≥66 year, preoperative potent
Erection	22/46 (47.8)
Masturbation/Coitus	15/46 (32.6)

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