Robotic radical prostatectomy: outcomes of 500 cases

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Abstract
To report the outcomes of 500 robotically assisted laparoscopic radical prostatectomies (RALPs), a minimally invasive alternative for treating prostate cancer. In all, 500 patients had RALP over a 30-month period. A transperitoneal six-port approach was used in each case, with the da Vinci robotic surgical system (Intuitive Surgical, Sunnyvale, CA, USA). Prospective data collection included quality-of-life questionnaires, basic demographics (height, weight and body mass index), prostate specific antigen (PSA) levels, clinical stage and Gleason grade. Variables assessed during RALP were operative duration, estimated blood loss (EBL) and complications, and after RALP were hospital stay, catheter time, pathology, PSA level, return of continence and potency. The mean (range) duration of RALP was 130 (51-330) min; all procedures were successful, with no intraoperative transfusions or deaths. The mean EBL was 10-300 mL; 97% of patients were discharged home on the first day after RALP with a mean haematocrit of 36%. The mean duration of catheterization was 6.9 (5-21) days. The positive margin rate was 9.4% for all patients; i.e. 2.5% for T2 tumours, 23% for T3a and 53% for T4. The overall biochemical recurrence free (PSA level<0.1 ng/mL) survival was 95% at mean follow-up of 9.7 months. There was complete continence at 3 and 6 months in 89% and 95% of patients, respectively. At 1 year 78% of patients were potent (with or without the use of oral medications), 15% were not yet able to sustain erections capable of intercourse, and another 7% still required injection therapy. RALP is a safe, feasible and minimally invasive alternative for treating prostate cancer. Our initial experience with the procedure shows promising short-term outcomes.