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Updated: Aug 13, 2026
Retzius-Sparing Robot-Assisted Radical Prostatectomy
Published on: May 19, 2022
Perioperative complications of laparoscopic and robotic assisted laparoscopic radical prostatectomy
Jim C Hu1, Rebecca A Nelson, Timothy G Wilson
1Division of Urology, Department of Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts 02115, USA. jhu2@partners.org
Purpose:
While it remains controversial whether LRP or da Vinci RAP offers any advantages over radical retropubic prostatectomy, LRP and RAP are being used more frequently. We reviewed our experience with these minimally invasive techniques.
Materials And Methods:
We reviewed intraoperative and early postoperative complications of 358 LRPs performed from October 2000 to January 2003 with those of 322 RAPs performed from June 2003 to June 2004. The transperitoneal approach with bilateral pelvic lymph node dissection was performed using each technique. Data acquisition was done independently of the 3 surgeons.
Results:
The LRP and RAP groups had similar clinical characteristics in terms of patient race, body mass index, prostate specific antigen, risk group, and pathological tumor grade and stage. Median operative time and estimated blood loss for LRP and RAP were 4.1 and 3.1 hours, and 200 and 250 ml, respectively. No blood transfusions were given intraoperatively, although 8 patients with LRP (2.2%) and 5 with RAP (1.6%) were transfused postoperatively. Of the LRP and RAP patients 21 (5.9%) and 3 (0.3%), respectively, experienced intraoperative complications. Postoperatively 48 patients with LRP (13.4%) and 24 with RAP (6.8%) experienced urine leakage, while 19 with LRP (5.3%) and 9 with RAP (2.8%) had ileus. There were no deaths, myocardial infarctions, pulmonary emboli or cerebrovascular accidents.
Conclusions:
In our series surgeon experience derived from LRP may contribute to the lower complication rate and operative time of RAP. Dissemination of surgical technique and management of complications may lead to improved perioperative LRP and RAP morbidity. However, the morbidity of these 2 approaches compares favorably with that of radical retropubic prostatectomy.
Insights
Laparoscopic radical prostatectomy (LRP) and robot-assisted radical prostatectomy (RAP) show favorable outcomes compared to traditional surgery. Surgeon experience may improve RAP outcomes, reducing operative time and complications.
Area of Science:
- Urology
- Minimally Invasive Surgery
- Surgical Oncology
Background:
- Radical prostatectomy is a standard treatment for prostate cancer.
- Laparoscopic radical prostatectomy (LRP) and robot-assisted radical prostatectomy (RAP) are increasingly utilized minimally invasive alternatives.
- The comparative advantages of LRP and RAP over radical retropubic prostatectomy (RRP) remain a subject of ongoing debate.
Purpose of the Study:
- To review and compare the intraoperative and early postoperative complications of LRP and RAP.
- To evaluate the learning curve and experience effect on outcomes for these procedures.
Main Methods:
- A retrospective review of 358 LRPs (Oct 2000-Jan 2003) and 322 RAPs (Jun 2003-Jun 2004).
- Both techniques utilized a transperitoneal approach with bilateral pelvic lymph node dissection.
- Data were collected independently of the three surgeons involved.
Main Results:
- Patient demographics and preoperative characteristics were similar between LRP and RAP groups.
- Median operative time was 4.1 hours for LRP and 3.1 hours for RAP; estimated blood loss was 200 ml for LRP and 250 ml for RAP.
- Intraoperative complications occurred in 5.9% of LRP and 0.3% of RAP patients. Postoperative urine leakage was observed in 13.4% of LRP and 6.8% of RAP patients. Ileus rates were 5.3% for LRP and 2.8% for RAP.
Conclusions:
- Surgeon experience gained from LRP may contribute to the improved outcomes observed with RAP.
- Dissemination of surgical techniques and effective complication management can enhance perioperative outcomes for both LRP and RAP.
- The morbidity associated with LRP and RAP compares favorably to that of radical retropubic prostatectomy.
