Robot-assisted laparoscopic radical prostatectomy: technique and outcomes of 700 cases

Robotic prostatectomy techniques are evolving rapidly as the procedure gains popularity and continues to be compared to the gold standard of open retropubic radical prostatectomy. Our objective is to report the operative technique and outcomes of 700 consecutive robotic radical prostatectomies performed by a single surgeon at Mount Sinai Medical Center between May 2007 and October 2008. Data was prospectively collected in an Internal Review Board (IRB)-approved database.

Key aspects of our technique include 1) dissection of the bladder neck first; 2) minimal to no use of cautery from posterior bladder neck dissection onward; 3) leaving endopelvic fascia intact until after neurovascular bundles dissected; 4) preservation of a wide margin of endopelvic fascia; 5) posterior dissection and nerve-sparing in a medial to lateral direction; 6) cold transection of the dorsal venous complex without prior ligation; and 7) posterior bladder neck reconstruction.

Mean OR time from skin incision to skin closure was 124 minutes [48-266]; mean robotic time was 88 minutes [36-190]. Mean EBL was 69.3ml [5-400]. Mean and median length of stay was 1 day. Overall complication rate was 3.3% with no mortalities and no conversions to open or laparoscopic approaches. The overall positive margin rate (PMR) was 11.9%. PMR was 1.4% for pT2a, 0% for pT2b, 8.3% for pT2c, 39.7% for pT3a, and 56.7% for pT3b. Biochemical recurrence rate at one year was 1.7%. Continence rate by 12 months was 94%. Potency rate by 12 months was 83%.

Both perioperative and postoperative outcomes of our series of robotic prostatectomies performed by a single surgeon at Mount Sinai Medical Center demonstrate the superb outcomes that can be achieved through this modality of treatment.