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Operative details and oncological and functional outcome of robotic-assisted laparoscopic radical prostatectomy: 400 cases with a minimum of 12 months follow-up.
Eur Urol. 2009 Jun; 55(6):1358-66.EU

Abstract

BACKGROUND

Robotic-assisted laparoscopic radical prostatectomy (RALP) using the da Vinci surgical system (Intuitive Surgical, Sunnyvale, CA) is increasingly used for the management of localised prostate cancer.

OBJECTIVE

We report the operative details and short-term oncological and functional outcome of the first 400 RALPs performed at our unit.

DESIGN, SETTING AND PARTICIPANTS

From December 2003 to August 2006, 400 consecutive patients underwent RALP at our institution. A prospective database was established to record the relevant details of all RALP cases.

SURGICAL PROCEDURE

A six port transperitoneal approach using a 4-arm da Vinci system was used to perform RALP. This database was reviewed to establish the operative details and oncological and functional outcome of all patients with a minimum of 12 months follow-up.

MEASUREMENTS

Perioperative characteristics and outcomes are reported. Functional outcome was assessed using continence and erectile function questionnaires. Biochemical recurrence (prostate-specific antigen (PSA) > or =0.2 ng/mL) is used as a surrogate for cancer control.

RESULTS AND LIMITATIONS

The mean age+/-standard deviation (SD) was 60.2+/-6 years. Median PSA level was 7.0 (interquartile range (IQR) 5.3-9.6) ng/mL. The mean operating time+/-SD was 186+/-49 mins. The complication rate was 15.75% comprising Clavien grade I-II and Clavien grade III complications in 10.5% and 5.25% of patients respectively. The overall positive surgical margin rate was 19.2% with T2 and T3 positive margin rates of 9.6% and 42.3% respectively. The biochemical recurrence-free survival was 86.6% at a median follow-up of 22 (IQR=15-30) months. At 12 months follow-up, 91.4% of patients were pad-free or used a security liner. Of those men previously potent (defined as Sexual Health Inventory for Men [SHIM] score > or =21) who underwent nerve-sparing RALP, 62% were potent at 12 months.

CONCLUSIONS

The safety and feasibility of RALP has already been established. Our initial experience with this procedure shows promising short-term outcomes.

Authors+Show Affiliations

Department of Urology, Epworth Hospital, Richmond, & Royal Melbourne Hospital, Australia. decmurphy@doctors.net.ukNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

19147274

Citation

Murphy, Declan G., et al. "Operative Details and Oncological and Functional Outcome of Robotic-assisted Laparoscopic Radical Prostatectomy: 400 Cases With a Minimum of 12 Months Follow-up." European Urology, vol. 55, no. 6, 2009, pp. 1358-66.
Murphy DG, Kerger M, Crowe H, et al. Operative details and oncological and functional outcome of robotic-assisted laparoscopic radical prostatectomy: 400 cases with a minimum of 12 months follow-up. Eur Urol. 2009;55(6):1358-66.
Murphy, D. G., Kerger, M., Crowe, H., Peters, J. S., & Costello, A. J. (2009). Operative details and oncological and functional outcome of robotic-assisted laparoscopic radical prostatectomy: 400 cases with a minimum of 12 months follow-up. European Urology, 55(6), 1358-66. https://doi.org/10.1016/j.eururo.2008.12.035
Murphy DG, et al. Operative Details and Oncological and Functional Outcome of Robotic-assisted Laparoscopic Radical Prostatectomy: 400 Cases With a Minimum of 12 Months Follow-up. Eur Urol. 2009;55(6):1358-66. PubMed PMID: 19147274.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Operative details and oncological and functional outcome of robotic-assisted laparoscopic radical prostatectomy: 400 cases with a minimum of 12 months follow-up. AU - Murphy,Declan G, AU - Kerger,Michael, AU - Crowe,Helen, AU - Peters,Justin S, AU - Costello,Anthony J, Y1 - 2009/01/09/ PY - 2008/08/22/received PY - 2008/12/25/accepted PY - 2009/1/17/entrez PY - 2009/1/17/pubmed PY - 2009/11/5/medline SP - 1358 EP - 66 JF - European urology JO - Eur Urol VL - 55 IS - 6 N2 - BACKGROUND: Robotic-assisted laparoscopic radical prostatectomy (RALP) using the da Vinci surgical system (Intuitive Surgical, Sunnyvale, CA) is increasingly used for the management of localised prostate cancer. OBJECTIVE: We report the operative details and short-term oncological and functional outcome of the first 400 RALPs performed at our unit. DESIGN, SETTING AND PARTICIPANTS: From December 2003 to August 2006, 400 consecutive patients underwent RALP at our institution. A prospective database was established to record the relevant details of all RALP cases. SURGICAL PROCEDURE: A six port transperitoneal approach using a 4-arm da Vinci system was used to perform RALP. This database was reviewed to establish the operative details and oncological and functional outcome of all patients with a minimum of 12 months follow-up. MEASUREMENTS: Perioperative characteristics and outcomes are reported. Functional outcome was assessed using continence and erectile function questionnaires. Biochemical recurrence (prostate-specific antigen (PSA) > or =0.2 ng/mL) is used as a surrogate for cancer control. RESULTS AND LIMITATIONS: The mean age+/-standard deviation (SD) was 60.2+/-6 years. Median PSA level was 7.0 (interquartile range (IQR) 5.3-9.6) ng/mL. The mean operating time+/-SD was 186+/-49 mins. The complication rate was 15.75% comprising Clavien grade I-II and Clavien grade III complications in 10.5% and 5.25% of patients respectively. The overall positive surgical margin rate was 19.2% with T2 and T3 positive margin rates of 9.6% and 42.3% respectively. The biochemical recurrence-free survival was 86.6% at a median follow-up of 22 (IQR=15-30) months. At 12 months follow-up, 91.4% of patients were pad-free or used a security liner. Of those men previously potent (defined as Sexual Health Inventory for Men [SHIM] score > or =21) who underwent nerve-sparing RALP, 62% were potent at 12 months. CONCLUSIONS: The safety and feasibility of RALP has already been established. Our initial experience with this procedure shows promising short-term outcomes. SN - 1873-7560 UR - https://www.unboundmedicine.com/medline/citation/19147274/Operative_details_and_oncological_and_functional_outcome_of_robotic_assisted_laparoscopic_radical_prostatectomy:_400_cases_with_a_minimum_of_12_months_follow_up_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0302-2838(08)01513-3 DB - PRIME DP - Unbound Medicine ER -