Comparison of Open and Robotic Surgery in Radical Prostatectomy: A Single Surgeon's Experience

Won Sik Ham; Sung Yul Park; Kang Su Cho; Jin Sun Lee; Young Deuk Choi

doi:10.4111/kju.2008.49.3.221

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Ham, Park, Cho, Lee, and Choi: Comparison of Open and Robotic Surgery in Radical Prostatectomy: A Single Surgeon's Experience

Original Article

Korean J Urol 2008;49(3):221-226.

Published online: 17 January 2008

DOI: https://doi.org/10.4111/kju.2008.49.3.221

Comparison of Open and Robotic Surgery in Radical Prostatectomy: A Single Surgeon's Experience

Won Sik Ham, Sung Yul Park, Kang Su Cho, Jin Sun Lee, Young Deuk Choi

¹Department of Urology and Urological Science Institute, Yonsei University College of Medicine, Seoul, Korea

교신저자: 최영득 세브란스병원 비뇨기과 서울시 서대문구 성산로 250 (신촌동 134) 120-752, TEL: 02-2228-2317, FAX: 02-312-2538 E-mail: youngd74@yuhs.ac

Revised 30 November 2007 Accepted 11 February 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

To compare the results of open radical prostatectomy (OP) and robotic prostatectomy (RP) for a single surgeon's experience of 219 radical prostatectomy cases.

Materials and Methods

Between June 2002 and June 2007, 133 patients underwent OP and between July 2005 and June 2007, 86 patients underwent RP. To compare the surgeon's experience-related differences, we divided the OP cases into 73 early cases (OP-I) and 60 late cases (OP-II), and the RP cases into 30 early cases (RP-I) and 56 late cases (RP-II). The clinical characteristics, perioperative results, and early clinical outcomes were evaluated.

Results

There were no significant differences in the preoperative characteristics between the four groups. For the RP cases, the mean estimated blood loss was decreased, a normal diet was started earlier, the mean duration of hospital stay and the mean duration of bladder catheterization was shorter than for the OP cases. The frequency of intraoperative complications significantly decreased in the RP-II group as compared to the RP-I group. Although there was no significant statistical difference in the positive surgical margin rates between the four groups, the rates were slightly decreased in the RP-II group. The recovery period of continence was shorter in the RP-II group than in the OP group and for patients 60 years or older, recovery of potency was also better in the RP-II group than the OP group.

Conclusions

Our results suggest that RP at the hands of an experienced surgeon may decrease the positive surgical margin rate to some degree. Additionally, performance of RP may lead to a shorter duration of bladder catheterization and hospital stay and a better recovery of continence and potency than obtainable by OP.

Keywords: Prostatic neoplasms, Open radical prostatectomy, Robotic radical prostatectomy

REFERENCES

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Table 1.

Preoperative patient characteristics

	OP		RP		p-value
	OP-I (n=73)	OP-II (n=60)	RP-I (n=30)	RP-II (n=56)	p-value
Age (year)	65.3±6.1	66.9±6.0	65.3±9.8	67.6±5.7	0.479^∗
BMI (kg/m²)	23.9±1.8	23.6±1.8	23.7±2.0	23.6±2.2	0.902^∗
Preoperative PSA (ng/ml)	21.1±20.6	55.2±237.0	9.9±6.4	21.3±33.5	0.370^∗
Biopsy Gleason score (%)					0.567^†
≤6	30 (41)	29 (48)	20 (67)	18 (32)
7	22 (30)	17 (28)	7 (23)	24 (43)
≥8	21 (29)	14 (23)	3 (10)	14 (25)
Clinical stage (%)					0.391^†
T1	46 (63)	38 (63)	26 (87)	38 (68)
T2	11 (15)	8 (13)	3 (10)	6 (11)
T3	16 (22)	13 (22)	0 (0)	11 (19)
T4	0 (0)	1 (2)	1 (3)	1 (2)

^∗ : ANOVA,

^† : Fisher's exact test, BMI: body mass index, OP: open radical retropubic prostatectomy, PSA: prostate-specific antigen, RP: robotic radical prostatectomy

Table 2.

Intraoperative and perioperative parameters according to the operative methods

	OP		RP		p-value
	OP-I (n=73)	OP-II (n=60)	RP-I (n=30)	RP-II (n=56)	p-value
Prostatectomy Gleason score (%)					0.281^‡
≤6	14 (19)	16 (27)	16 (53)	15 (27)
7	36 (49)	34 (57)	10 (33)	21 (37)
≥8	23 (32)	10 (16)	4 (13)	20 (36)
NVB saving (%)					＜0.001^‡
Bilateral	24 (33)	28 (47)	5 (17)	33 (59)
Unilateral	16 (22)	16 (27)	2 (7)	16 (29)
No saving	33 (45)	16 (27)	23 (77)	7 (13)
Pathologic stage (%)					0.326^‡
pT0	1 (1)	4 (7)	1 (3)	0 (0)
pT2	34 (47)	27 (45)	17 (57)	35 (63)
pT3	32 (44)	23 (38)	11 (37)	18 (32)
pT4	6 (8)	6 (10)	1 (3)	3 (5)
Lymph node invasion	(%) 14 (19)	5 (8)	0 (0)	4 (7)	0.025^‡
ECE (%)	41 (56)	31 (52)	12 (40)	20 (36)	0.150^§
Positive margin (%)	32 (44)	13 (22)	8 (27)	11 (20)	0.007^§
pT2 (n=113)	9/34 (26)	2/27 (7)	3/17 (18)	3/35 (9)	0.254^‡
pT3 (n=84)	14/32 (44)	8/23 (35)	4/11 (36)	5/18 (28)	0.158^‡
EBL (ml)^∗	1,085.5±107.0	785.5±108.0	659.0±157.0	335.6±146.0	＜0.001^†
T^∥	a	b	c	d
Postop diet (days)^∗	2.3±0.7	1.7±0.7	1.8±0.8	1.4±0.7	＜0.001^†
T^∥	a	b, c	b	c
Hospital stay (days)^∗	8.9±3.7	6.6±3.7	5.1±2.3	3.5±1.4	＜0.001^†
T^∥	a	b	c	d
Catheterization (days)^∗	14.9±1.7	13.3±1.7	11.8±1.9	9.5±1.5	＜0.001^†
T^∥	a	b	c	d
Complication (%)	7 (10)	4 (7)	5 (17)	1 (2)	0.075^‡
Major
Rectal injury	2 (3)	1 (2)	1 (3)	1 (2)
Infected hematom	ma 1 (1)	0 (0)	0 (0)	0 (0)
Minor
Retention	1 (1)	0 (0)	1 (3)	0 (0)
Anastomotic leak	age 1 (1)	1 (2)	1 (3)	0 (0)
Lymphocele	0 (0)	1 (2)	0 (0)	0 (0)
Ileus	2 (3)	1 (2)	2 (7)	0 (0)

^∗ Mean±SD, ECE: extracapsular extension, EBL: estimated blodd loss, NVB: neurovascular bundle, OP: open radical retropubic

^∥ : The same letters indicate

^‡ : Fisher's exact test,

^† : ANOVA,

^§ : chi-square test, prostatectomy, RP: robotic radical prostatectomy, non-significant differences between groups based on Turkey's multiple comparison test.

Table 3.

Re-obtainment of continence according to the operative methods

	OP		RP		p-value
	OP-I (n=73)	OP-II (n=60)	RP-I (n=30)	RP-II (n=56)	p-value
Continence (%)
Postoperative 1 month	14 (19.2)	27 (45.0)	15 (50.0)	29 (51.8)	＜0.001^∗
Postoperative 3 month	42 (57.5)	48 (80.0)	25 (83.3)	50 (89.3)	＜0.001^∗
Postoperative 6 month	60 (82.2)	53 (88.3)	27 (90.0)	54 (96.4)	0.083^∗

^∗ : chi-square test, OP: open radical retropubic prostatectomy, RP: robotic radical prostatectomy

Table 4.

Re-obtainment of an erection at postoperative 6 months according to the operative methods

	≤60 years	＞60 years
OP (%) (n=133)	11/23 (48)	38/110 (35)^†
OP-I (n=73)
Bilateral NVB saving (n=24)	5/5 (100)	10/19 (53)^∗
Unilateral NVB saving (n=16)	1/3 (33)	5/13 (39)
No NVB saving (n=33)	0/7 (0)	0/26 (0)
OP-II (n=60)
Bilateral NVB saving (n=28)	4/4 (100)	16/24 (67)^∗
Unilateral NVB saving (n=16)	1/2 (50)	7/14 (50)
No NVB saving (16)	0/2 (0)	0/14 (0)
RP (%) (n=86)	10/17 (59)	36/69 (52)^†
RP-I (n=30)
Bilateral NVB saving (n=5)	1/1 (100)	3/4 (75)^∗
Unilateral NVB saving (n=2)	1/1 (100)	0/1 (0)
No NVB saving (n=23)	1/7 (14)	0/16 (0)
RP-II (n=56)
Bilateral NVB saving (n=33)	5/5 (100)	25/28 (89)^∗
Unilateral NVB saving (16)	2/2 (100)	8/14 (57)
No NVB saving (n=7)	0/1 (0)	0/6 (0)

^∗ p=0.031 by Fisher's exact test,

^† p=0.041 by chi-square test,

NVB: neurovascular bundle, OP: open radical retropubic prostatectomy, RP: robotic radical prostatectomy

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