• Guillaume Ploussard, Alexandre de la Taille, Morgan Moulin, Dimitri Vordos, Andras Hoznek, Claude-Clément Abbou, and Laurent Salomon.
• Department of Urology, Hospital Henri Mondor, 51 Avenue du Maréchal de Lattre de Tassigny, 94010 Créteil, France. Electronic address: g.ploussard@gmail.com.
• Eur. Urol. 2014 Mar 1; 65 (3): 610-9.

BackgroundIn spite of the increasing use of robot-assisted radical prostatectomy (RALP) worldwide, no level 1 evidence-based benefit favouring RALP versus pure laparoscopic approaches has been demonstrated in extraperitoneal laparoscopic procedures.ObjectiveTo compare the operative, functional, and oncologic outcomes between pure laparoscopic radical prostatectomy (LRP) and RALP.Design, Setting, And ParticipantsFrom 2001 to 2011, 2386 extraperitoneal LRPs were performed consecutively in cases of localised prostate cancers.InterventionA total of 1377 LRPs and 1009 RALPs were performed using an extraperitoneal approach.Outcome Measurements And Statistical AnalysisPatient demographics, surgical parameters, pathologic features, and functional outcomes were collected into a prospective database and compared between LRP and RALP. Biochemical recurrence-free survival was tested using the Kaplan-Meier method. Mean follow-up was 39 and 15.4 mo in the LRP and RALP groups, respectively.Results And LimitationsShorter durations of operative time and of hospital stay were reported in the RALP group compared with the LRP group (p<0.001) even beyond the 100 first cases. Mean blood loss was significantly lower in the RALP group (p<0.001). The overall rate and the severity of the complications did not differ between the two groups. In pT2 disease, lower rates of positive margins were reported in the RALP group (p=0.030; odds ratio [OR]: 0.396) in multivariable analyses. The surgical approach did not affect the continence recovery. Robot assistance was independently predictive for potency recovery (p=0.045; OR: 5.9). Survival analyses showed an equal oncologic control between the two groups. Limitations were the lack of randomisation and the short-term follow-up.ConclusionsRobotic assistance using an extraperitoneal approach offers better results than pure laparoscopy in terms of operative time, blood loss, and hospital stay. The robotic approach independently improves the potency recovery but not the continence recovery. When strict indications of nerve-sparing techniques are respected, RALP gives better results than LRP in terms of surgical margins in pathologically organ-confined disease. Longer follow-up is justified to reach conclusions on oncologic outcomes.Copyright © 2012 European Association of Urology. Published by Elsevier B.V. All rights reserved.

22 keywords...

hide…