Pitfalls of robot-assisted radical prostatectomy: a comparison of positive surgical margins between robotic and laparoscopic surgery.

Abstract

OBJECTIVES:

To compare the surgical outcomes of laparoscopic radical prostatectomy and robot-assisted radical prostatectomy, including the frequency and location of positive surgical margins.

METHODS:

The study cohort comprised 708 consecutive male patients with clinically localized prostate cancer who underwent laparoscopic radical prostatectomy (n = 551) or robot-assisted radical prostatectomy (n = 157) between January 1999 and September 2012. Operative time, estimated blood loss, complications, and positive surgical margins frequency were compared between laparoscopic radical prostatectomy and robot-assisted radical prostatectomy.

RESULTS:

There were no significant differences in age or body mass index between the laparoscopic radical prostatectomy and robot-assisted radical prostatectomy patients. Prostate-specific antigen levels, Gleason sum and clinical stage of the robot-assisted radical prostatectomy patients were significantly higher than those of the laparoscopic radical prostatectomy patients. Robot-assisted radical prostatectomy patients suffered significantly less bleeding (P < 0.05). The overall frequency of positive surgical margins was 30.6% (n = 167; 225 sites) in the laparoscopic radical prostatectomy group and 27.5% (n = 42; 58 sites) in the robot-assisted radical prostatectomy group. In the laparoscopic radical prostatectomy group, positive surgical margins were detected in the apex (52.0%), anterior (5.3%), posterior (5.3%) and lateral regions (22.7%) of the prostate, as well as in the bladder neck (14.7%). In the robot-assisted radical prostatectomy patients, they were observed in the apex, anterior, posterior, and lateral regions of the prostate in 43.0%, 6.9%, 25.9% and 15.5% of patients, respectively, as well as in the bladder neck in 8.6% of patients.

CONCLUSIONS:

Positive surgical margin distributions after robot-assisted radical prostatectomy and laparoscopic radical prostatectomy are significantly different. The only disadvantage of robot-assisted radical prostatectomy is the lack of tactile feedback. Thus, the robotic surgeon needs to take this into account to minimize the risk of positive surgical margins.

• Authors: Keiichi Tozawa, Takahiro Yasui, Yukihiro Umemoto, Kentaro Mizuno, Atsushi Okada, Noriyasu Kawai, Satoru Takahashi, Kenjiro Kohri
• Journal: International journal of urology : official journal of the Japanese Urological Association (Int J Urol) Vol. 21 Issue 10 Pg. 976-9 (Oct 2014) ISSN: 1442-2042 [Electronic] Australia
• PMID: 24912809 (Publication Type: Comparative Study, Journal Article)
• Copyright: © 2014 The Japanese Urological Association.

Topics

• Adult
• Aged
• Blood Loss, Surgical
• Cohort Studies
• Humans
• Laparoscopy (adverse effects)
• Male
• Middle Aged
• Neoplasm, Residual
• Operative Time
• Prostatectomy (adverse effects, methods)
• Prostatic Neoplasms (pathology, surgery)
• Robotic Surgical Procedures (adverse effects)