Comparison of robotic-assisted versus retropubic radical prostatectomy performed by a single surgeon

To compare perioperative outcomes between patients undergoing robotic-assisted laparoscopic radical prostatectomy (RALP) and patients undergoing retropubic radical prostatectomy (RRP) performed by a single surgeon in Taiwan.

This study was a retrospective review of 30 consecutive patients who underwent RRP and 30 initial patients who underwent RALP. The preoperative parameters, operation parameters (operative time, vesicourethral anastomosis time, blood loss, transfusion and complication rates) and postoperative parameters (post-operative stay, catheter duration, cystography received, continence rate, sexual function and histopathologic factors) were evaluated.

Preoperative clinical parameters were similar between groups. Vesicourethral anastomosis time was shorter in RRP group than in RALP group. RRP had higher incidence of bilateral pelvic lymph node dissection than RALP (100% vs. 73.3%), but lower incidence of neurovascular bundle preservation (6.7% vs. 53.3%). Significant differences were found in blood loss (RALP 314 mL vs. RRP 912 mL) and transfusion rates (RALP 13.3% vs. RRP 60%) between groups. A statistically significant difference was found in incidence of cystograms performed between RRP and RALP groups (93.3% vs. 43.3%) before removing urethral catheter. Positive surgical margin was 20% in RRP group vs. 50% in RALP group, demonstrating statistical significance. Shorter catheterization duration and postoperative stays were found with RALP. Three-month continence rate was higher in RALP patients than in RRP patients (76.7% vs. 36.7%, p=0.04).

RALP is minimally invasive with less blood loss and lower transfusion rates than RRP. RALP had greater incidence of neurovascular bundle preservation and faster convalescence than RRP.