Open versus robotic radical prostatectomy: a prospective analysis based on a single surgeon's experience

The background of this study is to compare prospectively the oncological and functional results of open radical prostatectomy (OP) and robotic prostatectomy (RP) from the experience of a single surgeon. Between June 2002 and June 2007, 422 patients underwent radical prostatectomy (OP 199, RP 223). We divided OP patients into 89 early cases (OP-I) and 110 late cases (OP-II) before and after introduction of a robotic system, and RP patients into 35 early cases (RP-I) and 188 late cases (RP-II). Functional outcomes were measured by use of validated questionnaires completed by the patients. There were no significant differences in preoperative characteristics among the four groups, except that RP-I patients had lower biopsy Gleason scores. In the RP groups the mean estimated blood loss was lower and mean durations of hospital stay and bladder catheterization were shorter compared to those of the OP groups. The frequency of intraoperative complications was significantly lower in the RP-II group. The positive surgical margin rates in the RP-II group were similar to or lower than those in the OP groups when stratified by pathologic stage T2 and T3. From one month after surgery, RP-II patients had higher continence rates than OP-II patients. For patients ≥60 years old, recovery of potency was better in the RP-II group. To conclude, RP by an experienced surgeon may have a similar or lower positive surgical margin rate than OP. Additionally, RP may lead to a shorter duration of bladder catheterization and hospital stay and better recovery of continence and potency than obtainable by OP.