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Eur Urol. 2015 Jul;68(1):86-94. doi: 10.1016/j.eururo.2014.11.044. Epub 2014 Dec 4.

Perioperative Outcomes of Robotic and Laparoscopic Simple Prostatectomy: A European-American Multi-institutional Analysis.

Author information

1
University Hospitals Urology Institute, Cleveland, OH, USA. Electronic address: ricautor@gmail.com.
2
Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH, USA.
3
Section of Urology, Santa Casa de Misericordia de Porto Alegre, Rio Grande do Sul, Brazil.
4
Department of Urology, Institut Montsouris, Paris, France.
5
Department of Urology, La Floresta Medical Institute, Caracas, Venezuela.
6
Department of Urology, Collegium Medicum, Jagiellonian University, Cracow, Poland.
7
Department of Urology, Clinica Indisa, Universidad Andres Bello, Santiago, Chile.
8
Division of Urology, European Institute of Oncology, Milan, Italy.
9
Department of Urology, San Bassiano Hospital, Bassano del Grappa, Italy.
10
Department of Urology, Tepecik Teaching and Research Hospital, Izmir, Turkey.
11
Department of Urology, Cleveland Clinic Florida, Weston, FL, USA.
12
Department of Urology, University of Southern California, Los Angeles, CA, USA.
13
Department of Urology, University of California San Diego Health System, San Diego, CA, USA.
14
Uroclinic AB Robotic Surgery, Stockholm, Sweden.
15
Department of Surgery/Urology, Marshall University, Huntington, WV, USA.
16
Department of Urology, MultiCare Health System Tacoma, Tacoma, WA, USA.
17
Department of Urology, University of Turin, San Luigi Gonzaga Hospital, Orbassano, Italy; Department of Urology, O.L.V. Clinic, Aalst, Belgium.
18
Department of Urology, O.L.V. Clinic, Aalst, Belgium; Division of Urology, University of Eastern Piedmont, Maggiore della Carità Hospital, Novara, Italy.
19
Department of Urology, Faculty of Medicine, Uludag University, Bursa, Turkey.
20
Department of Urology, Georgetown University, Washington, DC, USA.
21
Department of Urology, Washington Hospital Center, Washington, DC, USA.
22
Department of Urology, Global Robotics Institute Orlando, Orlando, FL, USA.
23
Department of Urology, Denver Health Medical Center, Denver, CO, USA.
24
Department of Urology, Braga Hospital, Braga, Portugal.
25
University Hospitals Urology Institute, Cleveland, OH, USA.
26
Department of Urology, Mayo Clinic, Jacksonville, FL, USA.
27
Division of Urologic Surgery, University of Tennessee, Knoxville, Knoxville, TN, USA.
28
Department of Urology, O.L.V. Clinic, Aalst, Belgium.
29
Department of Urology, University of Turin, San Luigi Gonzaga Hospital, Orbassano, Italy.

Abstract

BACKGROUND:

Laparoscopic and robotic simple prostatectomy (SP) have been introduced with the aim of reducing the morbidity of the standard open technique.

OBJECTIVE:

To report a large multi-institutional series of minimally invasive SP (MISP).

DESIGN, SETTING, AND PARTICIPANTS:

Consecutive cases of MISP done for the treatment of bladder outlet obstruction (BOO) due to benign prostatic enlargement (BPE) between 2000 and 2014 at 23 participating institutions in the Americas and Europe were included in this retrospective analysis.

INTERVENTION:

Laparoscopic or robotic SP.

OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS:

Demographic data and main perioperative outcomes were gathered and analyzed. A multivariable analysis was conducted to identify factors associated with a favorable trifecta outcome, arbitrarily defined as a combination of the following postoperative events: International Prostate Symptom Score <8, maximum flow rate >15ml/s, and no perioperative complications.

RESULTS AND LIMITATIONS:

Overall, 1330 consecutive cases were analyzed, including 487 robotic (36.6%) and 843 laparoscopic (63.4%) SP cases. Median overall prostate volume was 100ml (range: 89-128). Median estimated blood loss was 200ml (range: 150-300). An intraoperative transfusion was required in 3.5% of cases, an intraoperative complication was recorded in 2.2% of cases, and the conversion rate was 3%. Median length of stay was 4 d (range: 3-5). On pathology, prostate cancer was found in 4% of cases. Overall postoperative complication rate was 10.6%, mostly of low grade. At a median follow-up of 12 mo, a significant improvement was observed for subjective and objective indicators of BOO. Trifecta outcome was not significantly influenced by the type of procedure (robotic vs laparoscopic; p=0.136; odds ratio [OR]: 1.6; 95% confidence interval [CI], 0.8-2.9), whereas operative time (p=0.01; OR: 0.9; 95% CI, 0.9-1.0) and estimated blood loss (p=0.03; OR: 0.9; 95% CI, 0.9-1.0) were the only two significant factors. Retrospective study design, lack of a control arm, and limited follow-up represent major limitations of the present analysis.

CONCLUSIONS:

This study provides the largest outcome analysis reported for MISP for BOO/BPE. These findings confirm that SP can be safely and effectively performed in a minimally invasive fashion in a variety of healthcare settings in which specific surgical expertise and technology is available. MISP can be considered a viable surgical treatment in cases of large prostatic adenomas. The use of robotic technology for this indication can be considered in centers that have a robotic program in place for other urologic indications.

PATIENT SUMMARY:

Analysis of a large data set from multiple institutions shows that surgical removal of symptomatic large prostatic adenomas can be carried out with good outcomes by using robot-assisted laparoscopy.

KEYWORDS:

Benign prostatic hyperplasia; Laparoscopy; Outcomes; Robotic surgery; Simple prostatectomy

PMID:
25484140
DOI:
10.1016/j.eururo.2014.11.044
[Indexed for MEDLINE]
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