scholarly journals Complications following robot-assisted radical prostatectomy in a prospective Canadian cohort of 305 consecutive cases

2013 ◽  
Vol 7 (3-4) ◽  
pp. 116-21 ◽  
Author(s):  
Andrew Fuller ◽  
Stephen E. Pautler
Keyword(s):  
Radical Prostatectomy ◽  
Major Complication ◽  
Robot Assisted ◽  
Pharmacological Management ◽  
Surgical Technology ◽  
Related Information ◽  
Open Radical Prostatectomy ◽  
Institutional Ethics ◽  
Patient Consent

Background: Robot-assisted radical prostatectomy (RARP) has emerged in the last decade as an alternative to open radical prostatectomy for men with localized prostate cancer. The increased cost of this technique has been justified by its ability to reduce blood loss, and to provide improved vision, less postoperative pain and more rapid recovery from surgery, while maintaining satisfactory oncological and functional outcomes. Given the increasing diffusion of robotic surgical technology within Canada and its associated high capital and operating costs, we review the clinical outcomes and complications from 305 consecutive cases performed at our Canadian institution.Methods: A consecutive cohort of 305 patients with a mean follow up of 30 months was analyzed with institutional ethics approval. All patients were treated and reviewed postoperatively by a single surgeon (SP). The primary aim of the study was to assess the incidence and type of complications associated with RARP in a Canadian setting. Our prospective database captured preoperative, intra-operative and postoperative data and was maintained by an individual independent of the robotic program. We report complications categorized according to the Clavien system. Multiple complications seen in an individual were recorded separately for the purposes of our analysis.Results: Between April 2005 and October 2010, 305 patients underwent RARP at our institution. A total of 70 complications were identified, with 47 (67.1%) requiring only conservative or pharmacological management (Clavien I-II). Twenty-three patients were found to have a major complication (Clavien III-V). Of the 16 who required intervention under general anesthesia, 3 required emergency treatment and the remaining patients underwent elective surgery.Conclusions: RARP has been incorporated at our institution with an acceptably low rate of intra-operative and postoperative complications. We have found that the database was effective in providing patients with outcome-related information, which in turn helped us gain patient consent with regard to the institution-specific risks of RARP.

Comparative Analysis of Results Between Robot-Assisted and Open Radical Prostatectomy

2019 ◽  
Vol 12 (2) ◽  
pp. 157-161
Author(s):  
Nikolay Kolev
Keyword(s):  
Prostate Cancer ◽  
Radical Prostatectomy ◽  
Functional Outcome ◽  
Erectile Function ◽  
Functional Outcomes ◽  
Operating Time ◽  
Robot Assisted ◽  
Open Radical Prostatectomy ◽  
Retropubic Radical Prostatectomy

Summary We aimed to compare results between patients with early- stage prostate cancer who underwent robot-assisted and open radical prostatectomy. We examined preoperative and postoperative data, early and late complications, and analysed oncological and functional outcomes (continence and erectile function) during follow-up. We studied the data of 123 patients with localized prostate cancer, operated with nerve-sparing retropubic radical prostatectomy, divided into two groups. Group 1 included 70 patients who underwent robot-assisted radical prostatectomy (RARP). Group 2 included 53 patients, on whom open retropubic radical prostatectomy (RRP) was performed. We compared preoperative data, complications rate, oncological, and functional outcome (continence and erectile function) during the follow-up period. Operative time was significantly lower in the RRP group. Blood loss and earlier removal of the urinary catheter were significantly lower in the RARP group. The percentage of significant postoperative complications (Clavien-Dindo III-IV) was 0% in the first group and 3% in the second group. During follow-up, the improvement in the functional outcome - continence and erectile function was significantly better in the robot-assisted surgery patients. There were statistically significant better functional outcomes in patients operated on using the robot-assisted technique. The operating time was shorter in the classic radical prostatectomy. The application of robot-assisted radical prostatectomy may help achieve earlier recovery, as compared to open radical prostatectomy.

scholarly journals Economic evaluation of robot-assisted radical prostatectomy compared to open radical prostatectomy for prostate cancer treatment in Ontario, Canada

2020 ◽  
Vol 14 (8) ◽  
Author(s):  
Anna Parackal ◽  
Jean-Eric Tarride ◽  
Feng Xie ◽  
Gord Blackhouse ◽  
Jennifer Hoogenes ◽  
...  
Keyword(s):  
Cost Effectiveness ◽  
Radical Prostatectomy ◽  
Time Horizon ◽  
Cost Effective ◽  
Cost Utility ◽  
Economic Evaluations ◽  
Base Case ◽  
Robot Assisted ◽  
Open Radical Prostatectomy ◽  
Life Years

Introduction: Recent health technology assessments (HTAs) of robot-assisted radical prostatectomy (RARP) in Ontario and Alberta, Canada, resulted in opposite recommendations, calling into question whether benefits of RARP offset the upfront investment. Therefore, the study objectives were to conduct a cost-utility analysis from a Canadian public payer perspective to determine the cost-effectiveness of RARP. Methods: Using a 10-year time horizon, a five-state Markov model was developed to compare RARP to open radical prostatectomy (ORP). Clinical parameters were derived from Canadian observational studies and a recently published systematic review. Costs, resource utilization, and utility values from recent Canadian sources were used to populate the model. Results were presented in terms of increment costs per quality-adjusted life years (QALYs) gained. A probabilistic analysis was conducted, and uncertainty was represented using cost-effectiveness acceptability curves (CEACs). One-way sensitivity analyses were also conducted. Future costs and QALYs were discounted at 1.5%. Results: Total cost of RARP and ORP were $47 033 and $45 332, respectively. Total estimated QALYs were 7.2047 and 7.1385 for RARP and ORP, respectively. The estimated incremental cost-utility ratio (ICUR) was $25 704 in the base-case analysis. At a willingness-to-pay threshold of $50 000 and $100 000 per QALY gained, the probability of RARP being cost-effective was 0.65 and 0.85, respectively. The model was most sensitive to the time horizon. Conclusions: The results of this analysis suggest that RARP is likely to be cost-effective in this Canadian patient population. The results are consistent with Alberta’s HTA recommendation and other economic evaluations, but challenges Ontario’s reimbursement decision.

scholarly journals Does transition from standard to Retzius-sparing technique in robot-assisted radical prostatectomy affect the functional and oncological outcomes?

2021 ◽  
Vol 93 (4) ◽  
pp. 399-403
Author(s):  
Hakan Anıl ◽  
Kaan Karamık ◽  
Ali Yıldız ◽  
Murat Savaş
Keyword(s):  
Radical Prostatectomy ◽  
Learning Curve ◽  
Surgical Margin ◽  
Nerve Sparing ◽  
Robot Assisted ◽  
Continence Status ◽  
Oncological Results ◽  
Group 2 ◽  
Group 1

Objective: To appraise the outcomes on the Retzius-sparing robot-assisted radical prostatectomy (Rs-RARP) learning curve of a surgeon with previous experience of anterior (standard) RARP. Materials and methods: The first 50 cases during the Rs-RARP learning curve (group 1) and 50 cases after the second 100 cases with the standard approach (group 2) were comprised in the study. Patients who used zero or one safety pads were considered continent. Erectile function recuperation was characterized as the competence to achieve penetrative intercourse without receiving any medication. All patients were reevaluated at two weeks, first, third, sixth, and 12th months after surgery using IIEF-5, PSA level, and continence status. Results: Immediate continence rates following catheter removal were 32/50 (64%) in Rs-RARP group and 26/50 (52%) in S-RARP group (p = 0.224). The continence recovery rate was 48/50 (96%) in Rs-RARP group and 46/50 (92%) in the S-RARP group at 12 months follow-up (p = 0.400). Total nerve-sparing surgery was enforced in 36/50 (72%) patients for group 1 and 35/50 (70%) patients for group 2. Potency recovery was 27/43 (62.8%) in Rs-RARP and 30/44 (68.2%) for S-RARP at 12 months follow up (p = 0.597). Surgical margin positivity was detected in 6/50 (12%) cases in the Rs-RARP group and in 4/50 (8%) cases in the S-RARP (p = 0.444). Conclusions: Functional and oncological results are not negatively affected in the first 50 cases for a surgeon who is experienced in S-RARP before transition to the Rs-RARP method.

scholarly journals Robot-assisted radical prostatectomy: 10-years follow-up of 60 initial patients

2021 ◽  
Vol 33 ◽  
pp. S23
Author(s):  
K. Kolontarev ◽  
V. Govorov ◽  
V. Diakov ◽  
K. Ramazanov ◽  
U. Pushkar
Keyword(s):  
Radical Prostatectomy ◽  
Robot Assisted

A comparative study of robot-assisted and open radical prostatectomy in 10 790 men treated by highly trained surgeons for both procedures

2019 ◽  
Vol 123 (6) ◽  
pp. 1031-1040 ◽  
Author(s):  
Alexander Haese ◽  
Sophie Knipper ◽  
Hendrik Isbarn ◽  
Hans Heinzer ◽  
Derya Tilki ◽  
...  
Keyword(s):  
Radical Prostatectomy ◽  
Comparative Study ◽  
Robot Assisted ◽  
Open Radical Prostatectomy
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