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PubMed1999

Fluorine-18-fluorodeoxyglucose positron emission tomography is useless for the detection of local recurrence after radical prostatectomy.

OBJECTIVE: After radical retropubic prostatectomy a rise of the prostate-specific antigen (PSA) indicates a local recurrent or metastatic disease. If the bone scan shows no apparent bone metastasis, morphological imaging methods like x-ray computed tomography, magnetic resonance imaging or transrectal ultrasound often cannot distinguish between postoperative scar and local recurrence. Therefore we investigated the feasibility of fluorine-18-fluorodeoxyglucose positron emission tomography (F-18 FDG PET) for metabolic characterization of prostatic cancer, especially for differentiation of scar or recurrent prostate cancer after radical prostatectomy. METHODS: Dynamic PET with 370 MBq F-18 deoxyglucose (F-18 FDG) up to 60 min p.i. was performed in 2 patients with biopsy-proven benign prostatic hyperplasia, in 11 patients with a histologically proven prostate cancer prior to radical retropubic prostatectomy (RRP) and 7 patients with suspected local recurrence (with negative bone scan) after RRP prior to biopsy of anastomosis (3 local recurrence, 4 postoperative scar). RESULTS: Prostate cancer showed a very low F-18 FDG uptake. The placement of regions of interest was only possible by the use of other imaging methods. There was not difference between the F-18 FDG uptake of benign prostate hyperplasia, prostate carcinoma, postoperative scar or local recurrence after radical prostatectomy. CONCLUSION: F-18 FDG seems not to be useful to distinguish between postoperative scar and local recurrence after radical prostatectomy.

Adenocarcinoma↗

PubMed2005

The window sign: an aid in laparoscopic and robotic radical prostatectomy.

AIM: Certain steps of laparoscopic radical prostatectomy (LRP) and robotic radical prostatectomy (RRP), such as identification of seminal vesicles, bladder neck and retroprostatic dissections are technically challenging specially during initial experience. We describe an important land mark -- "Window sign", which helps significantly during the procedure. METHODS: The seminal vesicles can be dissected either through the transperitoneal, subperitoneal or extraperitoneal approach. In transperitoneal approach the vas deferens, seminal vesicles and Denonvillier's fascia are dissected posteriorly, and this plane is re-entered after division of the prostate from the posterior bladder neck, and with division of the Denonvillier's fascia. The communication between the anteriorly and posteriorly dissected planes in the retrovesical and retroprostatic space is termed "the window." Alternatively, in the RRP technique, bladder neck is divided anteriorly and posteriorly and vas deferens and seminal vesicle pulled out through this window. We have found that this window in transperitoneal, subperitoneal or extraperitoneal approach whether done during laparoscopic or robotic radical prostatectomy, allows to retract the vas deferens and seminal vesicles to elevate the prostate, facilitates control of the prostatic pedicles, helps in dissection of the prostate and assists in the identification and careful avoidance of the neurovascular bundles. RESULTS: This window sign was identified on the basis of our experience of over 450 cases of laparoscopic and robotic anatomical radical prostatectomies. We have followed this step in all of the cases by either technique. CONCLUSION: The "window sign" is an important aid while performing laparoscopic and robotic radical prostatectomy. This technique helps the surgeon to achieve both the anatomic and oncologic goals of the nerve sparing, during anatomic radical prostatectomy.

Humans↗

PubMed1999

Serum half-life time determination of free and total prostate-specific antigen following radical prostatectomy--a critical assessment.

OBJECTIVES: All studies investigating the elimination kinetics of serum total (tPSA) and free (fPSA) prostate-specific antigen (PSA) were carried out in men undergoing radical prostatectomy. Radical prostatectomy itself could, however, have a major influence on the serum concentration of these tumor markers (e.g., perioperative fluid shift or blood loss). The purpose of our study was to determine the half-life time of fPSA and tPSA with special regard to the influence of the radical prostatectomy on the serum concentration of these tumor markers. METHODS: Eleven men (mean age 63.2+/-7.2 years) with organ-confined prostate cancer who underwent radical prostatectomy were investigated (final pathologic Stage pT2pN0 or lower). Serum samples were obtained preoperatively and 0.25, 0.5, 1, 2, 4, 8, 12, 16, 24, 48, 72, 120, 168, and 240 hours after removal of the prostate. fPSA and tPSA and albumin and total protein serum concentrations were determined in all samples. RESULTS: During the first 120 minutes after removal of the prostate, albumin and total protein serum concentrations continuously declined, with a half-life time of -104.5+/-28 minutes and -129.7+/-32 minutes, respectively. Serum decline of fPSA and tPSA followed a biphasic kinetic. During the initial alpha-phase, fPSA and tPSA serum concentrations decreased, with a half-life time of -69+/-10.3 minutes and -87.3+/-18.1 minutes, respectively. During the terminal beta-phase, the half-life time of fPSA and tPSA was -1152.2 minutes (0.8 days) and -3916.1 minutes (2.7 days), respectively. Between the alpha-phase half-life time of fPSA or tPSA and the half-life time of the total protein or albumin concentration decline, significant correlations were found. CONCLUSIONS: These correlations indicate that the rapid decline of fPSA and tPSA directly after removal of the prostate (alpha-phase half-life time) is caused by the radical prostatectomy itself. The half-life time of the beta-phase reflects the biologic clearance of PSA. Therefore, the half-life time determination of PSA after radical prostatectomy is of limited value if the influence of the operation itself on the serum PSA concentration is not taken into account.

Aged↗

PubMed2002

Laparoscopic radical prostatectomy: initial 70 cases at a U.S. university medical center.

OBJECTIVES: To report our experience with the first 70 cases of laparoscopic radical prostatectomy. Radical retropubic prostatectomy is an accepted therapy for the management of locally confined prostate cancer. Recently, laparoscopic prostatectomy has been introduced as a minimally invasive alternative to open radical prostatectomy. Several published series from Europe have demonstrated that laparoscopic radical prostatectomy is a safe and feasible approach to the management of localized prostate cancer. METHODS: From May 2000 to May 2001, transperitoneal laparoscopic radical prostatectomy was performed on 70 men, aged 40 to 76 years, who were appropriate candidates for radical retropubic prostatectomy. Patient characteristics, surgical statistics, and pathologic results were prospectively collected. RESULTS: The mean preoperative prostate-specific antigen level was 6.6 ng/mL (range 1.5 to 20.7). The preoperative Gleason sum was 6 in 53 patients (75.7%), 7 in 16 (22.9%), and 8 in 1 patient (1.4%). The mean operating time was 274 minutes (range 165 to 495). The estimated blood loss averaged 449 mL (range 50 to 2750), and 4 patients (5.7%) required blood transfusions. In 1 case, we converted to a standard retropubic approach. Two intraoperative (2.9%) and 14 (20%) overall postoperative complications occurred. Positive surgical margins were reported in 8 specimens (11.4%). At a minimum of 3 months' follow-up, 85% reported use of 0 or 1 pad per day. The operative times, amount of blood loss, and complication rate decreased dramatically with experience. CONCLUSIONS: Laparoscopic radical prostatectomy is a technically demanding procedure that is a feasible option for the surgical treatment of localized prostate cancer. The morbidity of this operation is significantly less than that of radical retropubic prostatectomy. The laparoscopic approach shows significant promise for reducing surgical morbidity and improving the anatomic radical prostatectomy.

Adult↗

PubMed2000

The effect of hospital volume on mortality and resource use after radical prostatectomy.

PURPOSE: The value of radical prostatectomy for patients with prostate cancer depends on low morbidity and mortality. We assessed whether patient outcome is associated with how many of these procedures are performed at hospitals yearly. MATERIALS AND METHODS: Using the Nationwide Inpatient Sample, which is a stratified probability sample of American hospitals, we identified 66,693 men who underwent radical prostatectomy between 1989 and 1995. Cases were categorized into volume groups according to hospital annual rate of radical prostatectomies performed, including low-fewer than 25, medium-25 to 54 and high-greater than 54. We performed multivariate logistic regression to control for patient characteristics when assessing the associations of hospital volume, in-hospital mortality and resource use. RESULTS: Overall adjusted in-hospital mortality after radical prostatectomy was relatively low (0.25%). However, patients at low volume centers were 78% more likely to have in-hospital mortality than those at high volume centers (adjusted odds ratio 1.78, 95% confidence interval 1.7 to 2.6). Overall length of stay decreased at all hospitals between 1989 and 1995. However, average length of stay was longer and total hospital charges were higher at low than at high volume centers (7.3 versus 6.1 days, p<0.0001, and $15,600 versus $13,500, p<0.0001, respectively). CONCLUSIONS: Hospital volumes inversely related to in-hospital mortality, length of stay and total hospital charges after radical prostatectomy. Further study is necessary to examine the association of hospital volume with other important outcomes, including incontinence, impotence and long-term patient survival after radical prostatectomy.

Hospital Costs↗

PubMed2001

Inefficient urethral milking secondary to urethral dysfunction as an additional risk factor for incontinence after radical prostatectomy.

PURPOSE: Continence after radical prostatectomy is thought to depend completely on the striated urethral sphincter. However, some patients complain only of occasional post-void dribbling. Therefore, we determined whether urethral dysfunction may be another cause of incontinence. MATERIALS AND METHODS: The sensory threshold of electric stimulation was measured by double ring electrodes in the membranous urethra and 2.5 cm. distal in 29 men before and in 29 after radical retropubic prostatectomy. In addition, voiding cystourethrography was performed in 66 patients before and in 49 after surgery to determine complete post-void urethral emptying or milking. RESULTS: The mean sensory threshold of the membranous urethra was 15 +/- 3 mA. preoperatively versus 38 +/- 17 postoperatively (p <0.0001). The sensory threshold 2.5 cm. further distal was 12 +/- 5 mA. before and 10 +/- 4 after radical prostatectomy, which was not statistically significant. Postoperatively in completely continent patients and in those with dribbling the mean threshold was 32 +/- 12 and 43 +/- 18 mA. in the membranous urethra (p = 0.09), and 11 +/- 4 and 9 +/- 4 mA. in the bulbar urethra, respectively, which was not statistically significant. Of the 66 patients 36 (55%) showed post-void urethral milking before surgery but only 8 of 49 (16%) showed it postoperatively (chi-square test p <0.0001), including 7 who were completely continent and 1 who complained of occasional post-void dribbling. CONCLUSIONS: After radical prostatectomy sensitivity of the membranous but not of the bulbar urethra is affected, correlating with postoperative continence. In addition, post-void dribbling seems to be associated with the loss of urethral milking. We conclude that preserving urethral function is another important continence factor after radical prostatectomy.

Aged↗

PubMed2004

Robotic radical prostatectomy: the European experience.

Radical prostatectomy is standard treatment for localized prostate cancer in young patients. The shortcomings of the laparoscopic approach have led to the use of robots to improve the precision and accuracy of anatomic dissection. The feasibility of using a remote-controlled robot to perform urologic procedures is established, especially for radical prostatectomy. This article reviews the European experience with robotic radical prostatectomy.

Europe↗

PubMed2006

Impact of a multidisciplinary continuous quality improvement program on the positive surgical margin rate after laparoscopic radical prostatectomy.

OBJECTIVE: Outcome after radical prostatectomy is highly sensitive to fine nuances in the surgical techniques. We sought to determine the impact of a process of continuous control and monitoring on the positive surgical margin rate in a contemporary series of laparoscopic radical prostatectomy. METHODS: Between January 2003 and October 2004, 301 men underwent laparoscopic radical prostatectomy for clinically localized prostate cancer (cT1-cT3a). A weekly case review conference involving surgeons, radiologists, and uropathologists was held to discuss the preoperative, intraoperative, and pathologic findings of significant cases. We analyzed the trend of positive surgical margins and compared the clinical and detailed pathologic characteristics of the cancer during the study period. RESULTS: We created logistic regression models with positive margin as the dependent variable and surgical experience as the predictor, adjusting for possible secular changes in disease severity (prostate-specific antigen, pathologic stage, and Gleason grade). There was a decrease in the rate of surgical margins: odds ratio 0.68/100 patients treated (95% confidence interval [CI] 0.44, 1.05; p=0.08). The predicted probability for a positive surgical margin falls from 17.3% for the first patient to 7.5% for the 301st. These values are close to the observed rates for the first and last 50 patients. There was no important change in surgical risk over the course of the study, and the rate of nerve sparing remained stable throughout the study period. CONCLUSIONS: In this contemporary series, which is unaffected by downward stage migration, the decreasing rate of positive surgical margins can be explained by subtle surgical technique modifications and a continuous multidepartmental effort for quality improvement.

Biopsy↗

PubMed2006

Karolinska prostatectomy: a robot-assisted laparoscopic radical prostatectomy technique.

OBJECTIVE: The last decade has witnessed an increasing trend towards minimally invasive management of prostate cancer, including laparoscopic and, more recently, robot-assisted laparoscopic prostatectomy. Several different laparoscopic approaches have been continuously developed during the last 5 years and it is still unclear which technique yields the best outcome. We present our current technique of robot-assisted laparoscopic radical prostatectomy. MATERIAL AND METHODS: The technique described has evolved during the course of >400 robotic prostatectomies performed by the robotic team since the robot-assisted laparoscopic radical prostatectomy program was introduced at Karolinska University Hospital in January 2002. SURGICAL PROCEDURE: Our procedure comprises several modifications of previously reported ones, and we utilize fewer robotic instruments to reduce costs. An extended posterior dissection is performed to aid in the bladder neck-sparing dissection. In nerve-sparing procedures the vesicles are divided to avoid damage to the erectile nerves. In order to preserve the apical anatomy the dorsal venous complex is incised sharply and is first over-sewn after the apical dissection is completed. CONCLUSIONS: Our technique enables a more fluent dissection than previously described robotic techniques. Minimizing changes of instruments and the camera not only cuts costs but also reduces inefficient operating maneuvers, such as switching between 30 degrees and 0 degrees lenses during the procedure. We present a technique which in our hands has achieved excellent functional and oncological results.

Humans↗

PubMed2005

Erectile dysfunction following radical prostatectomy.

Erectile dysfunction following radical prostatectomy for clinically localized prostate cancer is a known potential complication of the surgery. Because prostate cancer is diagnosed today more frequently than in the past and because the diagnosis is made in increasingly younger men, there is an urgent need to develop effective interventions that preserve erectile function after surgery. In this presentation, a 51-year-old man with adenocarcinoma of the prostate underwent a bilateral nerve-sparing radical prostatectomy, after which he lost natural erectile function for approximately 9 months. The case highlights the fact that following surgery in which the nerve-sparing radical prostatectomy technique is used, between 60% to 85% of men eventually recover erectile function. This constitutes a dramatic improvement over an earlier era, when postprostatectomy erectile dysfunction was the nearly universal rule. The case also emphasizes that despite expert application of the nerve-sparing prostatectomy technique, early recovery of natural erectile function is uncommon. Many patients experience erectile dysfunction for as long as 2 years after the procedure, requiring the use of erectile aids for sexual activity during this period until natural erections recover. Corrective, cause-specific advances such as neuromodulatory therapy offer valuable adjuncts to this surgery.

Erectile Dysfunction↗

PubMed1997

Pretreatment prostate specific antigen doubling times: use in patients before radical prostatectomy.

PURPOSE: We determined whether pre-radical prostatectomy prostate specific antigen (PSA) doubling time could predict pathological stage at radical prostatectomy or PSA failure postoperatively. We also sought to compare PSA doubling times from men with prostate cancer treated with radical prostatectomy to a group treated with radiation therapy. MATERIALS AND METHODS: Detailed followup was available for 150 patients with clinically localized prostate cancer who underwent radical prostatectomy from January 1993 to August 1995. PSA doubling time was calculated for all patients with 3 or more pre-radical prostatectomy PSA levels using linear regression. We assessed the association between PSA doubling time and PSA failure, pathologic stage at radical prostatectomy, final PSA before treatment and Gleason score. We compared our PSA doubling time values and distribution to a published series of patients with prostate cancer who had undergone radiation therapy. RESULTS: A total of 56 patients had 3 or more PSA values before treatment. Median followup was 17.3 months. PSA doubling time did not correlate with PSA failure, final PSA or Gleason score, but it did with pathological stage at radical prostatectomy (p = 0.0035 for positive margins, p = 0.025 for positive seminal vesicles). Our PSA doubling time and PSA failure rates did not differ from the radiation therapy population with similar followup times. CONCLUSIONS: Although studies from the radiation literature have shown PSA doubling time to be useful in predicting PSA failure after treatment for prostate cancer, our results do not confirm this finding. We did find a correlation with pathologic stage at radical prostatectomy, and so longer followup with more patients may confirm this in the future. We also found no significant differences in PSA doubling time between our patients and a group treated with radiation. At least for this parameter, patients with prostate cancer referred for radical prostatectomy and radiation therapy may be similar.

Aged↗

PubMed2000

Absence of urethral post-void milking: an additional cause for incontinence after radical prostatectomy?

OBJECTIVE: Urinary incontinence following radical prostatectomy is thought to be mainly due to stress leak as a result of sphincter insufficiency or detrusor dysfunction. However, a number of patients complain of stress-independent urinary leakage following voiding, i. e. a post-micturition dribble, of uncertain origin. In order to establish wether post-micturition dribble is related to altered post-void milking in the urethra, voiding cystourethrograms (VCUGs) were performed before and after radical prostatectomy and correlated with the presence of post-micturition dribble. METHODS: 23 VCUGs were recorded before and 19 VCUGs at 10-15 days following radical prostatectomy. A standard questionnaire regarding urinary symptoms was given to all patients pre- and postoperatively at defined intervals. RESULTS: 12 of 19 patients (63%) had post-void urethral milking prior to surgery, none of these reported post-micturition dribble. 6 of the 7 patients (86%) without post-void urethral milking reported post-micturition dribble. Postoperatively only 1 of 16 patients (6%) had post-void urethral milking. Of the 15 patients without postoperative urethral milking, 13 (87%) reported post-micturition dribble. The decrease in rate of milking and increase in rate of post-micturition dribble from before to after surgery was statistically significant (chi(2) test, p = 0.0001 and p<0.0001, respectively. CONCLUSIONS: These data suggest that post-void milk-out of the urethra is often absent in the early postoperative period after radical prostatectomy and that this is associated with post-micturition dribble. Aside from detrusor and sphincter dysfunction, urethral dysfunction, i.e. the absence of urethral post-void milking, seems to be an additional cause of incontinence following radical prostatectomy.

Aged↗

PubMed2005

Open versus laparoscopic radical prostatectomy.

Expert laparoscopic surgeons have demonstrated that laparoscopic radical prostatectomy with or without robotic assistance can be performed with excellent results. There is no evidence that laparoscopic radical prostatectomy with or without robotic assistance offers any clinically relevant advantage over open radical prostatectomy. Laparoscopic radical prostatectomy with or without robotic assistance requires a significant learning curve, is a longer surgical procedure, carries greater costs, and requires an expanded operating room team. The literature suggests that laparoscopic radical prostatectomy is associated with more intraoperative complications and higher positive surgical margins. The lesser amount of postoperative bleeding associated with laparoscopic radical prostatectomy is not clinically relevant. Laparoscopic radical prostatectomy is not associated with less pain and does not facilitate earlier urinary catheter removal. The best way to improve overall outcomes after radical prostatectomy is to direct patients to expert open or laparoscopic surgeons.

Journal Article↗

PubMed1996

Follow-up prostate cancer treatments after radical prostatectomy: a population-based study.

BACKGROUND: Radical prostatectomy is one of the most commonly used curative procedures for the treatment of localized prostate cancer. The probability that a patient will undergo additional cancer therapy after this procedure is largely unknown. PURPOSE: The objective was to determine the likelihood of additional cancer therapy after radical prostatectomy. METHODS: Data for this study were derived from a linked dataset that combined information from the Surveillance, Epidemiology, and End Results Program and Medicare hospital and physician claims. Records were included in this study if patient histories met the following criteria: (a) residing in Connecticut, Washington (Seattle-Puget Sound), or Georgia (Metropolitan Atlanta); (b) having been diagnosed with prostate cancer during the period from January 1, 1985, through December 31, 1991; (c) undergoing radical prostatectomy by December 31, 1992; and (d) having no evidence of other types of cancer. Patients were considered to have had additional cancer therapy if they had had radiation therapy, orchiectomy, and/or androgen-deprivation therapy by injection after radical prostatectomy. The interval between the initial treatment and any follow-up treatment was calculated from the date of radical prostatectomy to the 1st day of the follow-up cancer therapy. All presented probabilities are based on Kaplan-Meier estimates. RESULTS: The study population consisted of 3494 Medicare patients, 3173 of whom underwent radical prostatectomy within 3 months of prostate cancer diagnosis. Although radical prostatectomy is often reserved for localized cancer, less than 60% (1934) of patients whose records were included in this study had organ-confined disease, according to final surgical pathology. Overall, the 5-year cumulative incidence of having any additional cancer treatment after radical prostatectomy reached 34.9% (95% confidence interval [CI] = 31.5%-38.5%). For patients with pathologically organ-confined cancer, the 5-year cumulative incidence was 24.3% (95% CI = 20.0%-29.3%) overall and ranged from 15.6% (95% CI = 9.7%-24.5%) for well-differentiated cancer (Gleason scores 2-4) to 41.5% (95% CI = 27.9%-58.4%) for poorly differentiated cancer (Gleason scores 8-10). The corresponding figures for pathologically regional cancer were 22.7% (95% CI = 12.0%-40.5%) and 68.1% (95% CI = 58.7%-77.1%). CONCLUSION: Further treatment of prostate cancer was done in about one third of patients who had had a radical prostatectomy with curative intent and in about one quarter of patients who were found to have organ-confined disease. IMPLICATIONS: Given the common requirement for follow-up cancer treatments after radical prostatectomy and the uncertainties about the effectiveness of the various follow-up treatment strategies, further investigation of these treatments is warranted.

Aged↗

PubMed2001

Laparoscopic radical prostatectomy: assessment after 240 procedures.

Radical prostatectomy can be successfully performed by transperitoneal laparoscopy by a urologic team experienced in laparoscopy and radical prostatectomy. Operative and postoperative morbidity rates are low. Postoperative pain is minimal, allowing reduction of the length of hospital stay. The oncologic results seem satisfactory based on short-term follow-up. The improvement of the quality of intraoperative vision related to magnification of the image allows a more precise procedure. This subjective improvement of the quality of dissection should reduce the usual functional sequelae of conventional radical prostatectomy, such as incontinence and impotence. This finding needs to be confirmed by a larger series of patients with longer follow-up. Laparoscopic radical prostatectomy is now performed routinely and is proposed as a first-line surgical treatment for localized prostatic cancer at the authors' center.

Follow-Up Studies↗

PubMed2003

Laparoscopic [correction of laproscopic] management of rectal injury during laparoscopic [correction of laproscopic] radical prostatectomy.

PURPOSE: Rectal injury is a potential complication of radical prostatectomy. Because laparoscopic radical prostatectomy is still a challenging procedure, we review the incidence and management of rectal injury in 1,000 cases of consecutive laparoscopic radical prostatectomy performed at our institution. MATERIALS AND METHODS: Of the first 1,000 laparoscopic transperitoneal radical prostatectomies performed between January 1998 and April 2002, 13 (1.3%) were complicated by rectal injury. Mean patient age was 66.5 years (range 58 to 76) and mean prostate specific antigen was 12.9 ng./ml. (range 2.9 to 26). Clinical stage was T1c, T2a and T2b in 5, 7 and 1 patient, respectively. Mean preoperative Gleason score was 5.8 (range 3 to 8). Once recognized the rectal defect was closed laparoscopically in 2 layers and tested for the absence of leakage. Broad-spectrum intravenous antibiotics were given for 7 days. Oral liquids were started the day after surgery with a low residue diet, and a regular diet was started on postoperative day 5. Healing of the vesicourethral anastomosis was confirmed by voiding cystourethrogram on postoperative day 5. RESULTS: All patients underwent a non-nerve sparing procedure except 1 in whom unilateral neurovascular bundle preservation was done. Of 13 injuries 11 were diagnosed and repaired intraoperatively, and 2 were diagnosed postoperatively. Of the 11 cases of intraoperative diagnosis and repair 9 healed primarily without colostomy and peritonitis was diagnosed in the remaining 2 on days 3 and 4, respectively. Of the latter 2 patients 1 required repair of a small rectal defect without colostomy while the other required colostomy. Colostomy was performed in the 2 patients with delayed diagnosis on days 3 and 4 but even then a rectourethral fistula developed in 1, necessitating secondary repair. Average urethral catheterization time was 8.6 days for the 9 patients with an uneventful immediate postoperative course and mean hospital stay was 6.8 days. For the remaining 4 patients urethral catheterization duration was 12, 13, 15 and 120 days, and hospital stay was 7, 16, 21 and 27 days, respectively. There was no perioperative mortality. CONCLUSIONS: Rectal injury during laparoscopic radical prostatectomy requires meticulous intraoperative repair in 2 layers, which allows primary healing without diversion colostomy. For injury prevention scrupulous attention is required during non-nerve sparing radical prostatectomy, particularly at the posterior surface of the prostatic apex.

Aged↗

PubMed2006

Critical comparison of laparoscopic, robotic, and open radical prostatectomy: techniques, outcomes, and cost.

Radical prostatectomy has maintained paramount importance in prostate cancer management. Emerging alternative treatments are laparoscopic and robotic prostatectomy. Technical modifications have improved radical prostatectomy outcomes, yet surgery remains difficult to perform regardless of approach. Contemporary series have shown comparable outcomes with operative time, transfusion rates, analgesia, and length of catheterization. Open radical prostatectomy provides excellent long-term oncologic control, but sparse short-term data are available for laparoscopic and robotic prostatectomy. Favorable outcomes also have been reported for urinary control and sexual function, regardless of approach. Additional prospective data collection is needed to evaluate if minimally invasive approaches provide distinct advantages over open surgery.

Costs and Cost Analysis↗

PubMed2004

Vattikuti Institute prostatectomy, a technique of robotic radical prostatectomy for management of localized carcinoma of the prostate: experience of over 1100 cases.

Advances in surgical techniques, technology, and surgeons' skills have allowed robot-assisted radical prostatectomy to be an option in the management of organ-confined prostate cancer. The goals of the VIP technique are to cure cancer, preserve urinary continence, preserve potency, and decrease morbidity, along with the benefits of a minimally invasive surgery and excellent cosmesis. VIP is nearly equal to traditional retro-pubic prostatectomy, with certain outstanding advantages.

Equipment Design↗