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|Title:||Operative details and oncological and functional outcome of robotic-assisted laparoscopic radical prostatectomy: 400 cases with a minimum of 12 months follow-up.|
|Keywords:||Robotic-Assisted Laparoscopic Radical Prostatectomy|
da Vinci Surgical System
Cancer of the Prostate
Six Port Transperitoneal Approach
Sexual Dysfunction, Physiological
Sexual Health Inventory for Men
UroRenal & Vascular Clinical Institute, Epworth HealthCare, Richmond, Victoria, Australia.
Cancer Services Clinical Institute, Epworth HealthCare, Victoria, Australia
Australian Prostate Cancer Research Centre, Epworth HealthCare, Richmond, Victoria, Australia.
|Citation:||Eur Urol. 2009 Jun;55(6):1358-66.|
|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.|
|Journal Title:||European Urology|
|Affiliated Organisations:||Department of Urology, The Royal Melbourne Hospital, Parkville, Victoria, Australia.|
|Type of Clinical Study or Trial:||Prospective Cohort Study|
|Appears in Collections:||Cancer Services|
Epworth Prostate Centre
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