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Eur Urol. 2009 Jun;55(6):1358-66. doi: 10.1016/j.eururo.2008.12.035. Epub 2009 Jan 9.

Operative details and oncological and functional outcome of robotic-assisted laparoscopic radical prostatectomy: 400 cases with a minimum of 12 months follow-up.

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1
Department of Urology, Epworth Hospital, Richmond, & Royal Melbourne Hospital, Australia. decmurphy@doctors.net.uk

Abstract

BACKGROUND:

Robotic-assisted laparoscopic radical prostatectomy (RALP) using the da Vinci surgical system (Intuitive Surgical, Sunnyvale, CA) is increasingly used for the management of localised prostate cancer.

OBJECTIVE:

We report the operative details and short-term oncological and functional outcome of the first 400 RALPs performed at our unit.

DESIGN, SETTING AND PARTICIPANTS:

From December 2003 to August 2006, 400 consecutive patients underwent RALP at our institution. A prospective database was established to record the relevant details of all RALP cases.

SURGICAL PROCEDURE:

A six port transperitoneal approach using a 4-arm da Vinci system was used to perform RALP. This database was reviewed to establish the operative details and oncological and functional outcome of all patients with a minimum of 12 months follow-up.

MEASUREMENTS:

Perioperative characteristics and outcomes are reported. Functional outcome was assessed using continence and erectile function questionnaires. Biochemical recurrence (prostate-specific antigen (PSA) > or =0.2 ng/mL) is used as a surrogate for cancer control.

RESULTS AND LIMITATIONS:

The mean age+/-standard deviation (SD) was 60.2+/-6 years. Median PSA level was 7.0 (interquartile range (IQR) 5.3-9.6) ng/mL. The mean operating time+/-SD was 186+/-49 mins. The complication rate was 15.75% comprising Clavien grade I-II and Clavien grade III complications in 10.5% and 5.25% of patients respectively. The overall positive surgical margin rate was 19.2% with T2 and T3 positive margin rates of 9.6% and 42.3% respectively. The biochemical recurrence-free survival was 86.6% at a median follow-up of 22 (IQR=15-30) months. At 12 months follow-up, 91.4% of patients were pad-free or used a security liner. Of those men previously potent (defined as Sexual Health Inventory for Men [SHIM] score > or =21) who underwent nerve-sparing RALP, 62% were potent at 12 months.

CONCLUSIONS:

The safety and feasibility of RALP has already been established. Our initial experience with this procedure shows promising short-term outcomes.

PMID:
19147274
DOI:
10.1016/j.eururo.2008.12.035
[Indexed for MEDLINE]
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