Every setback is a setup for a comeback: 3D laparoscopic radical prostatectomy after robotic radical prostatectomy

Area of Science:

• Urology
• Surgical Oncology
• Minimally Invasive Surgery

Background:

• Robotic radical prostatectomy (RALP) is a common minimally invasive approach.
• Transitioning to new surgical technologies like 3D high-definition laparoscopy (3D LRP) requires evaluation.
• The impact of prior robotic experience on adopting 3D LRP is not well-defined.

Purpose of the Study:

• To evaluate if prior robotic surgery experience influences the learning curve for 3D laparoscopic radical prostatectomy (LRP).
• To compare perioperative, short-term oncologic, and functional outcomes between RALP and 3D LRP.
• To assess the role of robotic surgery experience in the transition to 3D LRP.

Main Methods:

• Comparative analysis of 248 patients undergoing RALP (2009-2015) and 98 patients undergoing 3D LRP (2015-present).
• Procedures performed by two surgeons transitioning from open to robotic, then to 3D laparoscopic surgery.
• Patient groups were matched for age, PSA, clinical stage, and D'Amico risk stratification.

Main Results:

• Operative time was significantly shorter for 3D LRP (110 min difference, p<0.0001).
• Positive surgical margin rates were comparable overall, with improvement in pT3 patients (40.8% to 25%) for 3D LRP.
• No significant differences observed in biochemical recurrence, continence, or potency at 3 and 6 months post-procedure.

Conclusions:

• Prior robotic surgery experience enables a rapid and effective transition to 3D LRP.
• 3D LRP offers comparable oncologic and functional outcomes to RALP.
• The transition to 3D LRP is associated with shorter operative times and potentially reduced costs.