Laparoscopic Radical Prostatectomy After Robotic Radical Prostatectomy Training: A Matched Pair Analysis of a Single Surgeon Experience

Abstract

Objective: The authors compared the perioperative, oncological, and functional outcomes of a single surgeon’s prior experience with robot assisted laparoscopic prostatectomy (RALP) to those of laparoscopic radical prostatectomy (LRP) which he performed later after RALP.

Methods: This was a retrospective study on patients who underwent LRP and RALP by a single surgeon who performed a similar antegrade approach to the prostate. Patients’ clinical characteristics were collected— then a 1:1 pairing on LRP to RALP patients with the same preoperative profile. Paired t-test with a level of significance was set at p<0.05 using MedCalc.

Results: One hundred cases were done from April 2011 to March 2020. Out of eighty-four with sufficient data, twelve pairs were matched with no significant difference on age (p=0.13), BMI (p=0.26), clinical stage (p=1.0), prostate size (p=0.46), PSA (p=0.40) and Gleason score (p=1.0). Significant difference was noted on lymph node dissection (p=0.003), number of isolated lymph nodes (p=0.038), duration of procedure (p=0.0263), and surgical margin (p=0.0069). No significant difference on lymph node yield (p=0.67), blood loss (p=0.95), hospital stay duration (p=0.71), perineural invasion (p=0.894), lymphovascular invasion (p=0.4783), extracapsular extension (p=0.843), seminal vesicle involvement (p=0.4783), follow-up PSA (p=1.000) for two years, complications (p=0.09), return of continence (p=0.287) and erectile dysfunction (p=1.0).

Conclusion: A trained robotic surgeon can perform laparoscopic radical prostatectomy with comparable perioperative, oncologic, and functional outcomes.