Related Experiment Video
Updated: May 9, 2026
Retzius-Sparing Robot-Assisted Radical Prostatectomy
Published on: May 19, 2022
Perioperative outcomes for laparoscopic and robotic compared with open prostatectomy using the National Surgical
Jen-Jane Liu1, Bryan G Maxwell, Periklis Panousis
1Department of Urology, Stanford University School of Medicine, Stanford, CA, USA. jenjaneliu@gmail.com
Objective:
To examine contemporary outcomes of minimally invasive radical prostatectomy (MIRP) compared with open prostatectomy, using a national, prospective perioperative database reflecting diverse practice settings.
Methods:
The National Surgical Quality Improvement Program database was queried from 2005 to 2010 for laparoscopic or robotic prostatectomy (Current Procedural Terminology code 55866) and open retropubic prostatectomy (Current Procedural Terminology codes 55840, 55842, 55845). Perioperative outcomes examined were surgical and total operation duration, transfusion rates, length of stay, major morbidity (cardiovascular, pulmonary, renal, and infectious), and mortality.
Results:
The study identified 5319 radical prostatectomies: 4036 MIRP and 1283 open. Although operative time was significantly longer in the MIRP group, there were significantly fewer perioperative blood transfusions and shorter mean length of stay. Major postoperative morbidity and mortality were 5% in the MIRP group and 9% in the open group (P <.001). Age, body mass index, presence of medical comorbidities, and open surgical technique were all independently predictive of major complications and mortality on multivariate analysis.
Conclusion:
In a nationwide database of diverse medical centers, MIRP was associated with longer operative time, but a significantly decreased rate of blood transfusions, length of stay, perioperative complication rate, and mortality compared with open prostatectomy. The minimally invasive surgical approach was independently associated with significantly fewer complications and deaths on multivariate analysis. Compared with other administrative databases that capture only inpatient events, the National Surgical Quality Improvement Program identifies complications up to 30 days postoperatively, providing more detailed characterization of complications after prostatectomy. These data reflect contemporary practice patterns and suggest that MIRP can be performed with low perioperative morbidity.
Insights
Minimally invasive radical prostatectomy (MIRP) shows improved outcomes compared to open surgery. MIRP significantly reduces complications, blood transfusions, and hospital stays, making it a safe and effective option.
Area of Science:
- Urology
- Surgical Oncology
- Minimally Invasive Surgery
Background:
- Radical prostatectomy is a standard treatment for prostate cancer.
- Minimally invasive radical prostatectomy (MIRP) has gained popularity, but its outcomes compared to open prostatectomy require ongoing evaluation.
Purpose of the Study:
- To compare contemporary perioperative outcomes of MIRP versus open prostatectomy using a national prospective database.
- To identify factors influencing major complications and mortality after radical prostatectomy.
Main Methods:
- Analysis of the National Surgical Quality Improvement Program database (2005-2010).
- Inclusion of 5319 radical prostatectomies: 4036 MIRP and 1283 open.
- Evaluation of operative duration, transfusion rates, length of stay, major morbidity, and mortality.
Main Results:
- MIRP had longer operative times but significantly fewer blood transfusions and shorter hospital stays.
- Major postoperative morbidity and mortality were lower in the MIRP group (5%) compared to the open group (9%).
- Open surgical technique, age, BMI, and comorbidities independently predicted complications.
Conclusions:
- MIRP is associated with decreased perioperative complications, blood transfusions, length of stay, and mortality compared to open prostatectomy.
- The National Surgical Quality Improvement Program provides comprehensive 30-day postoperative complication data.
- MIRP can be performed with low perioperative morbidity in diverse practice settings.
