ROBOT-ASSISTED LAPAROSCOPIC PROSTATECTOMY: OUR EXPERIENCE

Background. Retropubic radical prostatectomy (RPE) is now the gold standard of treatment for locally advanced prostate cancer (PC). However, robot-assisted RPE procedures using the da Vinci system are finding increasing acceptance.

Materials and methods. The authors conducted a prospective study of 60 robot-assisted prostatectomies made at the Clinic of Urology, N.I. Pirogov National Medical Surgical Center, in the period January 2009 to December 2010.

Results. The duration of an operation averaged 230 min; the average amount of blood loss was 200 ml. The mean duration of postoperative analgesia was 2,7 days. That of urinary catheterization was 8.5 days. A normal postoperative course was noted in most cases (88,4 %). Seven patients were found to have 8 (13,3 %) mild and moderate complications. A pathohistological study revealed a positive surgical margin of resection in 21,7 % of the patients, extracapsular tumor growth in 21,7 %, and seminal vesicle invasion in 23,3 %. Tumor-affected regional lymph nodes were detected in 1 (1,7 %) patient. In our observed series, 82 and 93 % of the subjects completely retained urine after 6 and 12 moths, respectively. Throughout the follow-up, erectile function recovered in 7 of the 15 patients undergoing a nerve-sparing surgical procedure.

Conclusion. Postoperative results in our series of interventions are comparable to those obtained in the studies by Russian and foreign colleagues at the early stage of mastering this procedure. By considering a few observations, it is today difficult to say that our study is valid in the context of evidence-based medicine. Estimation of the benefits of robot-assisted laparoscopic prostatectomy calls for long-term multicenter randomized trials.

1. Lepor H., Walsh P.C. Long-term results of radical prostatectomy in clinically localized prostate cancer: experience at the Johns Hopkins Hospital. NCI monogr 1988;(7):117−22.

2. Walsh P.C., Lepor, H. The role of radical prostatectomy in the management of prostatic cancer. Cancer 1987;60:526−37.

3. Ahlering T.E., Woo D., Eichel L. et al. Successful transfer of open surgical skills to a laparoscopic environment using a robotic interface: initial experience with laparoscopic radical prostatectomy. J Urol 2003;170:1738−41.

4. Menon M., Shrivastava A., Tewari A. et al. Laparoscopic and robot assisted radical prostatectomy: establishment of a structured program and preliminary analysis of outcomes. J Urol 2002;168:945−9.

5. Patel H.R., Linares A., Joseph J.V. Robotic and laparoscopic surgery: cost and training. Surg Oncol 2009;18:242–6.

6. Murphy D., Kerger M., Crowe H. et al. Operative details and oncological and functional outcome of robotic-assisted laparoscopic radical prostatectomy: 400 cases with a minimum of 12 months follow-up. Eur Urol 2009; 55:1358–67.

7. Coelho R., Rocco B., Patel M.B. et al. Retropubic, laparoscopic, and robot-assisted radical prostatectomy: a critical review ofoutcomes reported by high-volume centers. J Endourol 2010;24(12): 2003–15.

8. Di Pierro G. B., Baumeister Ph., Stucki P. et al. A prospective trial comparing consecutive series of open retropubic and robot-assisted laparoscopic radical prostatectomy in a centre with a limited caseload. Eur Urol 2011;59: 1−6.

9. Thaly R., Shah K., Patel V. Applications of robots in urology. J Robotic Surgery 2007;1:3–17.

10. Dindo D., Demartines N., Clavien P.A. Classification of surgical complications: A new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg 2004;240:205–13.

11. Badani K.K., Kaul S., Menon M. Evolution of robotic radical prostatectomy: assessment after 2766 procedures. Cancer 2007;110:1951–58.

12. Jeong J., Choi E.Y., Kim I.Y. Clavien classification of complications after the initial series of robot-assisted radical prostatectomy: the Cancer Institute of New Jersey/Robert Wood Johnson Medical School Experience. J Endourol 2010;24:9.

13. Пушкарь Д.Ю., Раснер П.И., Колонтарев К.Б. Радикальная простатэктомия с роботической ассистенцией: анализ первых 80 случаев. Онкоурология 2010;3:37−47.

14. Schroeck F.R., Sun L., Freedland S.J. et al. Comparison of prostate-specific antigen recurrence-free survival in a contemporary cohort of patients undergoing either radical retropubic or robot-assisted laparoscopic radical prostatectomy. BJU Int 2008;102:28–32.

15. Menon M., Bhandari M., Gupta N. et al. Biochemical recurrence following robotassisted radical prostatectomy: analysis of 1384 patients with a median 5-year follow-up. Eur Urol 2010;58:838–45.

16. Frota R., Turna B., Barros R. et al. Comparison of radical prostatectomy techniques: open, laparoscopic and robotic assisted. Int Braz J Urol 2008;4: 259−69.

17. Hakimi A.A., Blitstein J., Feder M. et al. Direct comparison of surgical and functional outcomes of robotic-assisted versus pure laparoscopic radical prostatectomy: singlesurgion experience. Urology 2009;73:119−23.

18. Menon M., Shrivastava A., Kaul S. et al. Vattikuti Institute prostatectomy: contemporary technique and analysis of results. Eur Urol 2007; 1 (suppl 1):15–21.

19. Costello A.J., Haxhimolla H., Crowe H., Peters J.S. Installation of telerobotic surgery and initial experience with telerobotic radical prostatectomy. BJU Int 2005;96(1):34−8.

20. Ferrandino M., Albala D. State of the art: robotic radical prostatectomy. Division of Urology, Department of Surgery, Duke University Medical Center, Durham, North Carolina, USA. Www.ttmed.com.