Comparative studies of robot-assisted surgery,laparoscopic,and retropubic radical prostatectomy

Objective To assess the efficiency and safety of robot-assisted radical prostatectomy(RARP) and to compare it with laparoscopic radical prostatectomy(LRP) and retropubic radical prostatectomy(RRP). Methods We performed a non-randomized,prospective comparative study to evaluate 5 consecutive patients receiving RARP with da Vinci S surgical system(da Vinci Intuitive Surgical Inc.,Sunnyvale,CA,USA) from July 2009 to May 2010.And we enrolled 5 consecutive patients for LRP and 5 for RRP during the same period.The clinical data of patients in the above three groups were compared and analyzed.Results All patients in the 3 groups received successful operation.The 5 patients in the RARP group encountered no technique events and they were not transferred to other operations.For RARP.the median preoperative set-up time of the da Vinci S surgical system was 55(45-90) min.The median operating time was 240(220-300) min,the estimated blood loss was 200(50 - 600) mL and no patients needed transfusion.The patients were ambulant between 2nd and 3rd postoperative day and discharged on postoperative day 5 to 8.Foley catheter was removed on postoperative day 10 to 14.Histopathology confirmed that one patient had positive surgical margin,and the t-PSA was less than 0.2 ng/mL during follow-up(1-12 months).Two cases had slight incontinence during one month after operation. For the 5 patients receiving LRP,the median operation time was 200(180-270) min,and mean blood loss was 150(50-500) mL,with no blood transfusion.The patients were ambulant between the 4th and 5th postoperative day and discharged on postoperative day 6 to 16;the Foley catheter was removed on postoperative day 14 to 21.Histopathology confirmed that one patient had positive surgical margin,and the t-PSA was less than 0.2 ng/mL during follow-up.Conclusions Robot-assisted radical prostatectomy has the advantage of mini-invasiveness. less blood loss,rapid postoperative recovery,and it is safe,reliable and should be taken as the first choice for radical prostatectomy.RARP offers better results than LRP and RRP in terms of minimal invasiveness.RARP is becoming the preferred approach for radical prostatectomy.