Laparoscopic and Robot Assisted Radical Prostatectomy: Establishment of a Structured Program and Preliminary Analysis of Outcomes

Abstract

No AccessJournal of UrologyCLINICAL UROLOGY: ORIGINAL ARTICLES1 Sep 2002Laparoscopic and Robot Assisted Radical Prostatectomy: Establishment of a Structured Program and Preliminary Analysis of Outcomes Mani Menon, Alok Shrivastava, Ashutosh Tewari, Richard Sarle, Ashok Hemal, James O. Peabody, and Guy Vallancien Mani MenonMani Menon , Alok ShrivastavaAlok Shrivastava , Ashutosh TewariAshutosh Tewari , Richard SarleRichard Sarle , Ashok HemalAshok Hemal , James O. PeabodyJames O. Peabody , and Guy VallancienGuy Vallancien View All Author Informationhttps://doi.org/10.1016/S0022-5347(05)64548-XAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract Purpose: The technique of laparoscopic radical prostatectomy is difficult to master and is associated with a steep learning curve. We hypothesized that a structured approach to establishing a laparoscopic prostatectomy program would diminish complications during the learning process and that robotic technology would be useful in learning the operation. Materials and Methods: A structured laparoscopic radical prostatectomy program was introduced at the Vattikuti Urology Institute on October 23, 2000. One of 2 surgeons with a combined experience of more than 500 laparoscopic radical prostatectomies performed or supervised the first prostatectomies, training a third surgeon with extensive "open" surgical skills but no laparoscopic experience. The "trained" surgeon then started performing the operation independently with robotic assistance. The results of this approach were analyzed at the end of 12 months. Results: We performed 48 laparoscopic radical prostatectomies and 50 robot assisted prostatectomies within the 12-month period. The preoperative and intraoperative demographical variables were comparable in both groups as were the operative times, changes in hemoglobin concentrations, durations of hospitalization, positive margin rates and overall complication rates. All measured parameters were comparable to the "best-in-class" values for laparoscopic radical prostatectomy reported in the literature. Conclusions: A structured approach minimizes complications during the establishment of laparoscopic radical prostatectomy program. Robotic assistance helps skilled "open" surgeons learn the technique of laparoscopic radical prostatectomy. References 1 : Laparoscopic radical prostatectomy: initial short-term experience. Urology1997; 50: 854. Crossref, Medline, Google Scholar 2 : Laparoscopic radical prostatectomy: the Montsouris technique. J Urol2000; 163: 1643. Link, Google Scholar 3 : Laparoscopic radical prostatectomy: preliminary results. Urology2000; 55: 630. Crossref, Medline, Google Scholar 4 Menon, M., Tewari, A., Baize, B. et al: A prospective comparison of robot assisted anatomic prostatectomy and conventional radical retropubic prostatectomy: the early experience at the Vattikuti Urology Institute. Unpublished data Google Scholar 5 : The University of Massachusetts technique of radical retropubic prostatectomy. Eur J Surg Oncol1995; 21: 66. Crossref, Medline, Google Scholar 6 : Laparoscopic radical prostatectomy: assessment after 240 procedures. Urol Clin North Am2001; 28: 189. Crossref, Medline, Google Scholar 7 : Laparoscopic radical prostatectomy with the Heilbronn technique: an analysis of the first 180 cases. J Urol2001; 166: 2101. Link, Google Scholar 8 : Laparoscopic radical prostatectomy. The Creteil Experience. Eur Urol2001; 40: 38. Crossref, Medline, Google Scholar 9 : Laparoscopic radical prostatectomy. Technical aspects experience with 125 cases. Eur Urol2001; 40: 46. Crossref, Medline, Google Scholar 10 : Intraoperative postoperative complications of radical retropubic prostatectomy in a consecutive series of 1,000 cases. J Urol2001; 166: 1729. Link, Google Scholar 11 : Laparoscopic radical prostatectomy: irrational exuberance?. Urology2001; 58: 503. Crossref, Medline, Google Scholar 12 : Laparoscopic radical prostatectomy: CON. Urology2001; 58: 506. Crossref, Medline, Google Scholar 13 : [Remote laparoscopic radical prostatectomy carried out with a robot. Report of a case.]. Prog Urol2000; 10: 520. Medline, Google Scholar 14 : Telesurgical laparoscopic radical prostatectomy. Initial experience. Eur Urol2001; 40: 75. Crossref, Medline, Google Scholar 15 : Robotically-assisted laparoscopic radical prostatectomy. BJU Int2001; 87: 408. Crossref, Medline, Google Scholar 16 : Robotically-assisted laparoscopic radical prostatectomy: feasibility study in men. Eur Urol2001; 40: 70. Crossref, Medline, Google Scholar 17 : Extraperitoneal laparoscopic radical prostatectomy. Results after 50 cases. Eur Urol2001; 40: 65. Crossref, Medline, Google Scholar 18 : Complications initial experience with 1228 laparoscopic radical prostatectomies at 6 European centers. J Urol2001; 165: 150. Google Scholar 19 Aristotle: Nichomachean Ethics, Book 1, chapt 7.16, 350 BC Google Scholar From the