scholarly journals A meta-analysis of robot assisted laparoscopic radical prostatectomy versus laparoscopic radical prostatectomy

Open Medicine ◽  
2019 ◽  
Vol 14 (1) ◽  
pp. 485-490 ◽  
Author(s):  
Tao Wang ◽  
Qunsuo Wang ◽  
Songtao Wang
Keyword(s):  
Prostate Cancer ◽  
Postoperative Complications ◽  
Radical Prostatectomy ◽  
Meta Analysis ◽  
Surgical Margin ◽  
Laparoscopic Radical Prostatectomy ◽  
Localized Prostate Cancer ◽  
Urinary Continence ◽  
Robot Assisted ◽  
Continence Rate

AbstractObjectiveTo evaluate the efficacy and safety of robot-assisted laparoscopic radical prostatectomy (RALP) and laparoscopic radical prostatectomy (LRP) for the treatment of localized prostate cancer.MethodsMeta-analysis was applied using Review Manager V5.3 software and the retrieved clinical trials comparing RALP with LRP for the treatment of localized prostate cancer published from 2000 to 2018 in PubMed, Ovid, ScienceDirect, and EMBASE datasets were analyzed.ResultsThis meta-analysis included 16 articles, totaling 7952 patients, with 5170 RALP patients and 2782 LRP patients. Meta-analysis showed that RALP postoperative complications were fewer (P=0.0007), and the postoperative urinary continence rate was better at 1 year after surgery (P<0.00001). There was no statistical significance between RALP and LRP with regards to the positive incidence of surgical margin (P = 0.18).ConclusionAs an emerging technology, RALP is superior to LRP for localized prostate cancer treatment in terms of postoperative complications, and postoperative urinary continence rate.

scholarly journals Multiparametric MRI in planning of organ-sparing robot-assisted radical prostatectomy for treatment of localized prostate cancer with low and intermediate risk of progression

2021 ◽  
Vol 22 (2) ◽  
pp. 35-44
Author(s):  
I. A. Rezvikh ◽  
L. M. Rapoport ◽  
L. L. Chuvalov ◽  
E. S. Belisheva ◽  
A. A. Chibarov ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Radical Prostatectomy ◽  
Surgical Margin ◽  
Localized Prostate Cancer ◽  
Nerve Sparing ◽  
Intermediate Risk ◽  
Anterior Surface ◽  
Robot Assisted ◽  
Study Objective ◽  
Tumor Lesion

The study objective is to study the role of multiparametric magnetic resonance imaging (mpMRI), to predict extracapsular extension, infiltration of the seminal vesicles, neurovascular bundles and status of positive surgical margin (PSM) in robot-assisted radical prostatectomy (RARP) with fascio- and nerve-sparing and anatomy-sparing techniques in patients with low and intermediate oncological risk; to evaluate safety of RARP with anatomy-sparing techniques in the context of oncological results in the studied patient cohort.Materials and methods. Fifty-four males underwent mpMRI in the device with magnetic field density 3 Tesla without endorectal coil. Results of mpMRI were analyzed using PI-RADS v.2. Prostate-specific antigen level, results of prostate biopsy, nomogram were analyzed. All patients were included into groups with low and intermediate oncological risk. The patients underwent RARP with anatomy-sparing techniques. Gross specimen removed during the surgery was stained with tissue stain DECOLA and subjected to stepwise pathomorphological analysis. Comparative analysis of tumor lesion localization was performed for mpMRI and pathomorphological examination. The study concentrated on the largest tumor lesion locations. The anterior surface of the prostate was examined in detail. Patients were classified per risk groups in accordance with the National Comprehensive Cancer Network (NCCN) and D'Amico criteria.Results. Full or partial overlap of the lesions per mpMRI and pathomorphological examination were observed in 48 (88.9 %) patients; locations of tumor lesions disagreed in 6 (11.1 %) patients. PSM was detected in 8 (14.8 %) patients; among them in 7 (12.9 %) the size was between 0.1 and 0.4 cm. On the anterior surface of the prostate 3 (5.5 %) PSM were observed, 2 of which were between 0.14 and 0.4 cm, 1 was multifocal, larger than 0.3 cm. Per mpMRI results and histological examination, the anterior surface (fibromuscular stroma) was affected in 14 (25.9 %) and 11 (20.4 %) cases, respectively. Among them, lesion locations overlapped in 11 observations. Results of anatomy-sparing RARP show increased PSM rate compared to traditional nerve-sparing based on the anterior surface of the prostate.Conclusion. Routine mpMRI for patients who are planned to undergo RARP allows to justify selection of anatomy-sparing RARP or rejection of modification in favor of more thorough dissection. mpMRI plays a significant role on planning of anatomy-sparing RARP, achievement of negative surgical margin in patients with low and intermediate risk of oncological progression. Evaluation of the location and size of cancer lesion in the prostate allows to plan for special aspects of anatomy- and/or nerve-sparing techniques, achieve lower PSM rate, optimize oncological and functional surgical results in localized prostate cancer.

scholarly journals Denonvilliers’ Fascia Acts as the Fulcrum and Hammock for Continence After Radical Prostatectomy

2021 ◽  
Author(s):  
Xuwei Lu ◽  
Chang He ◽  
Sihong Zhang ◽  
Fan Yang ◽  
Zhuifeng Guo ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Radical Prostatectomy ◽  
Surgical Margin ◽  
Primary Treatment ◽  
Localized Prostate Cancer ◽  
Urinary Continence ◽  
Positive Surgical Margin ◽  
Significant Difference ◽  
Group Control ◽  
Retropubic Radical Prostatectomy

Abstract Background: Radical prostatectomy (RP) is the primary treatment of localized prostate cancer. Immediate urinary incontinence post-RP was still common and depressing without specific reason.Methods: A multicenter cohort of 154 consecutive patients from 2018 to 2020, who was diagnosed with localized prostate cancer underwent either modified mini-incision retropubic radical prostatectomy (Mmi-RRP) or laparoscopic radical prostatectomy (LRP) or robotic-assisted radical prostatectomy (RARP). Seventy-two patients with DF spared were included in DFS group. Whereas eighty-two patients with DF completely or partially dissected were set as Group Control. The primary outcome was Immediate continence (ImC). Continuous data and categorical data were analyzed with t-test and Chi-square test, respectively. Odds ratios (ORs) were calculated with logistic regression.Results: Urinary continence of Group DFS was significantly better than that of Group Control at each time point within one year after operation. Incidence rate of continence in Group DFS and Group Control were 83.3% vs 13.4% (P<0.001) for ImC, 90.3% vs 30.5% (P<0.001) at 3months, 91.7% vs 64.6% (P<0.001) at 6months, and 93.1% vs 80.5% (P=0.023) at 1year after operation, respectively. Positive surgical margin (PSM) showed no significant difference (20.8% vs 20.7%, P=0.988). In multivariate analysis, DFS showed importance for ImC post RP (OR=26.418, P<0.001).Conclusions: Denonvilliers’ fascia acted as the fulcrum and hammock for continence post RP. Preservation of DF contributed to better continence after RP without increase of PSM.Trail registration: Our research was conducted retrospectively and approved by the ethical committees of Minhang Hospital, but not registered.

scholarly journals Retzius-sparing robot-assisted radical prostatectomy: initial experience and surgical technique

2020 ◽  
Vol 9 (4) ◽  
pp. 19-24
Author(s):  
Dmitry M. Ilin ◽  
Bahman G. Guliev
Keyword(s):  
Prostate Cancer ◽  
Radical Prostatectomy ◽  
Surgical Technique ◽  
Intraoperative Complications ◽  
Surgical Margin ◽  
Operation Time ◽  
Localized Prostate Cancer ◽  
Positive Surgical Margin ◽  
Initial Experience ◽  
Robot Assisted

To present own initial experience of Retzius-sparing robot-assisted radical prostatectomy (RS-RARP) and surgical technique. In OctoberNovember 2019 on the basis of the Urological Department and the Center for Robotic Surgery of City Mariinsky Hospital (Saint Petersburg, Russia) five patients with localized prostate cancer were treated with RS-RARP. The operation time was from 140 to 205 min. The blood loss volume was from 50 to 250 ml. No conversions and intraoperative complications were recorded. Nervous-saving RS-RARP was performed in three patients. No blood transfusions were performed. Two patients faced Clavien Grade I postoperative complications. Immediate continence after removal of the urethral catheter was noted in 3 out of 5 patients. All the patients became continent for 2 weeks. One extraprostatic positive surgical margin was recorded. RS-RARPis an accessible technique for treating patients with localized prostate cancer, which allows achieving high early results. It is necessary to accumulate more experience of such surgeries to assess the distant outcomes and compare them with the data of the robot-assisted radical prostatectomies performed by other approaches.

scholarly journals Denonvilliers’ fascia acts as the fulcrum and hammock for continence after radical prostatectomy

BMC Urology ◽  
2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Xuwei Lu ◽  
Chang He ◽  
Sihong Zhang ◽  
Fan Yang ◽  
Zhuifeng Guo ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Radical Prostatectomy ◽  
Surgical Margin ◽  
Primary Treatment ◽  
Localized Prostate Cancer ◽  
Urinary Continence ◽  
Positive Surgical Margin ◽  
Significant Difference ◽  
Group Control ◽  
Retropubic Radical Prostatectomy

Abstract Background Radical prostatectomy (RP) is the primary treatment of localized prostate cancer. Immediate urinary incontinence post-RP was still common and depressing without specific reason. Methods A multicenter cohort of 154 consecutive patients from 2018 to 2020, who was diagnosed with localized prostate cancer underwent either modified mini-incision retropubic radical prostatectomy (Mmi-RRP) or laparoscopic radical prostatectomy (LRP) or robotic-assisted radical prostatectomy (RARP). Seventy-two patients with Denonvilliers’ fascia (DF) spared were included in DFS (Denonvilliers’ fascia sparing) group. Whereas eighty-two patients with DF completely or partially dissected were set as Group Control. The primary outcome was immediate continence (ImC). Continuous data and categorical data were analyzed with t-test and Chi-square test, respectively. Odds ratios (ORs) were calculated with logistic regression. Results Urinary continence of Group DFS was significantly better than that of Group Control at each time point within one year after operation. Incidence rate of continence in Group DFS and Group Control were 83.3% vs 13.4% (P < 0.01) for ImC, 90.3% vs 30.5% (P < 0.01) at 3 months, 91.7% vs 64.6% (P < 0.01) at 6 months, and 93.1% vs 80.5% (P = 0.02) at 1 year after operation, respectively. Positive surgical margin (PSM) showed no significant difference (20.8% vs 20.7%, P = 1.0). In multivariate analysis, DFS showed importance for ImC post RP (OR = 26.4, P < 0.01). Conclusions Denonvilliers’ fascia acted as the fulcrum and hammock for continence post RP. Preservation of DF contributed to better continence after RP without increase of PSM. Trail registration Our research was conducted retrospectively and approved by the ethical committees of Minhang Hospital, but not registered.

Laparoscopic Transperitoneal Radical Prostatectomy: Surgical Technique. A Personal Experience

2007 ◽  
Vol 74 (3) ◽  
pp. 164-172
Author(s):  
R.F. Liotta ◽  
M.L. Tarantino ◽  
D. Melloni
Keyword(s):  
Prostate Cancer ◽  
Radical Prostatectomy ◽  
Surgical Technique ◽  
Personal Experience ◽  
Standard Of Care ◽  
Laparoscopic Radical Prostatectomy ◽  
Localized Prostate Cancer ◽  
Urinary Continence ◽  
Urological Procedures ◽  
Laparoscopic Transperitoneal

At present, radical prostatectomy is the standard of care for localized prostate cancer. Several mini-invasive urological procedures have been developed during the last years, such as the laparoscopic radical prostatectomy, which is nowadays an innovative technique for urologists. This procedure shows many benefits in terms of anatomic accuracy, reduction of hospitalization and transurethral catheterization, recovery of urinary continence and sexual potency. In this study we have described the laparoscopic radical prostatectomy technique which is carried out by urologists at the “Hôpital Henry Mondor” - Creteil, Paris, where the first author has worked for six months.

scholarly journals Comparing Urinary and Sexual Complications of Robot-Assisted Radical Prostatectomy and Laparoscopic Radical Prostatectomy in Prostate Cancer: a Systematic Review and Meta-Analysis Protocol

2021 ◽  
Author(s):  
Afshin Heidari ◽  
◽  
Aida Kazemi ◽  
Parisa Najjari ◽  
Kamran Dalvandi ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Systematic Review ◽  
Radical Prostatectomy ◽  
Meta Analysis ◽  
Prostate Gland ◽  
Laparoscopic Radical Prostatectomy ◽  
Robot Assisted ◽  
Conventional Laparoscopic ◽  
Review Question ◽  
Analysis Protocol

Review question / Objective: The aims of this study are: 1. To compare urinary complications of robot-assisted radical prostatectomy(RARP) and laparoscopic radical prostatectomy(LRP) in patients with prostate cancer; 2. To compare sexual complications of RARP and LRP in patients with prostate cancer. Condition being studied: Prostate cancer is one of the most prevalent types of cancer; according to 2018 statistics, prostate cancer was responsible for 7.1% of all cancer in men. The primary intervention in such patients is radical prostatectomy surgery (RP), which could be performed in different methods in patients that cancer has not spread beyond the prostate gland or has not spread much. One of the most common types of RP is laparoscopic radical prostatectomy. There are several techniques for performing RP; two are Conventional Laparoscopic Radical Prostatectomy (LRP) and Robot-Assisted Radical Prostatectomy (RARP). Sexual and urinary difficulties can occur in prostate cancer patients due to cancer itself or the treatment. Like any treatment option and surgery, radical prostatectomy can carry risks, like urinary(e.g., incontinency) and sexual complications(e.g., Impotence). In this review, we compared urinary and sexual complications of LRP and RARP.

scholarly journals Functional and Oncological Outcomes Following Robot-Assisted and Laparoscopic Radical Prostatectomy for Localized Prostate Cancer With a Large Prostate Volume: A Retrospective Analysis With Minimum 2-Year Follow-Ups

2021 ◽  
Vol 11 ◽  
Author(s):  
Wen Deng ◽  
Xiaoqiang Liu ◽  
Weipeng Liu ◽  
Cheng Zhang ◽  
Xiaochen Zhou ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Postoperative Complications ◽  
Radical Prostatectomy ◽  
Prostate Volume ◽  
Localized Prostate Cancer ◽  
Oncologic Outcomes ◽  
Robot Assisted ◽  
Post Operation ◽  
Grade Ii ◽  
Large Prostate

ObjectiveWe aimed to analyze the perioperative, functional, and oncologic outcomes following robot-assisted radical prostatectomy (RARP) and laparoscopic radical prostatectomy (LRP) for patients with localized prostate cancer (PCa) characterized by a large prostate volume (PV; ≥50 ml) over a minimum of 2 years follow-up.Materials and MethodsPatients undergoing RARP and LRP for localized PCa with a large PV were included in the final analysis. The perioperative, functional, and oncologic outcomes were analyzed between the two groups.ResultsAll operations were successfully completed without open conversion in both groups. The mean operative time and estimated blood loss in the RARP group were significantly decreased compared to those in the LRP group (139.4 vs. 159.0 min, p = 0.001, and 124.2 vs. 157.3 ml, p = 0.003, respectively). Patients in the RARP arm had significantly lower proportions of grade II or lower and of higher than grade II postoperative complications compared with those in the LRP group (7.9% vs. 17.1%, p = 0.033, and 1.6% vs. 6.7%, p = 0.047, respectively). No significant differences in terms of the rates of pT3 disease, positive surgical margin, and positive lymph node were noted between the two groups. Moreover, no significant difference in the median specimen Gleason score was observed between the RARP and LRP groups (6 vs. 7, p = 0.984). RARP vs. LRP resulted in higher proportions of urinary continence upon catheter removal (48.4% vs. 33.3%, p = 0.021) and at 3 (65.1% vs. 50.5%, p = 0.025) and 24 (90.5% vs. 81.0%, p = 0.037) months post-operation. The median erectile function scores at 6 and 24 months post-operation in the RARP arm were also significantly higher than those in the LRP arm (15 vs. 15, p = 0.042, and 15 vs. 13, p = 0.026, respectively). Kaplan–Meier analyses indicated that the biochemical recurrence-free survival and accumulative proportion of continence were statistically comparable between the two groups (p = 0.315 and p = 0.020, respectively).ConclusionsFor surgically managing localized PCa with a large prostate (≥50 ml), RARP had a tendency toward a lower risk of postoperative complications and better functional preservation without cancer control being compromised when compared to LRP.

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