ROBOT-ASSISTED RADICAL PROSTATECTOMY: ANALYSIS OF THE FIRST 80 CASES

Background. As a common disease, prostate cancer (PC) has taken now first place among all malignancies in many countries of the world.The authors have analyzed the results of their series of robot-assisted radical laparoscopic prostatectomy (RALP) in patients with PC. They also present a number of surgical techniques that may be useful for novice surgeons. Materials and methods. In November 2008 to November 2009, the Department of Urology, Moscow State University of Medicine and Dentistry, performed 80 RALPs using the da Vinci S surgical robotic system. The patients’ mean age was 63.7 (49–71) years; the mean blood level of total prostate-specific antigen was 6.1 (2.1–20.84) ng/ml; the mean prostate volume was 44 (18–94) cm3, as evidenced by transrectal ultrasound study. The authors analyzed the following indicators: operating time, degree of blood loss, conversion of surgical intervention,degrees of intra- and postoperative complications, and oncological and functional results. Results. In our series, RALP was performed without preserving neurovascular bundles or by using a nerve-sparing procedure in 66 (82.5%) and 14 (17.5%), respectively; 22 (27.5%) patients underwent lymphadenectomy. The average length of hospital stay was 7 (4–21) days; the mean time of urethral catheter removal was 10 (6–21) days postoperatively. The mean time of surgical intervention was 174 (121–276) min. Mean blood loss was 248 (35–1950) ml. Postmortem study revealed a positive surgical margin in 19 (24%) cases and tumor invasion into the seminal vesicles in 5 (6%) patients. Stages pT2 and pT3 were found in 56 (70%) and 24 (30%), respectively; total Gleason scores were 6 (3+3), 7 (3+4), 7 (4+3), 8 (4+4) in 38 (47.5%), 35 (43.75%), 5 (6.25%), and 2 (2.5%) patients, respectively. Among 34 patients examined 3 months after RALP, 28 (82.4%) patients completely retained urine; 5 (14.7%) applied not more than a pad a day. In patients with preserved erectile function, the latter cannot be presently evaluated because the follow-up was short and operations performed by a nervesparing procedure were few. Conclusion. The results of analyzing our series of RALP, by using the da Vinci S surgical robotic system, are similar to those of analyzing the first experience with such interventions performed by foreign colleges. By taking into account a small number of our cases analyzed, it is difficult to speak reliably about complications caused by RALP. Studies involving a large number of cases are needed to reliably estimate these findings and to analyze a postoperative period and functional results.

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