Cáceres Felipe, Sánchez Carlos, Martínez-Piñeiro Luis, Tabernero Angel, Alonso Sergio, Cisneros Jesús, Cabrera Castillo Pedro Manuel, Alvarez Maestro Mario, Martín Hernández Mario, Pérez-Utrilla Pérez Manolo, de la Peña Jesús J
Servicio de Urologia, Hospital General La Paz, Paseo Castellana, 261 U 28045 Madrid, España.
Arch Esp Urol. 2007 May;60(4):430-8. doi: 10.4321/s0004-06142007000400013.
laparoscopic surgery has demonstrated that it is a good alternative to conventional surgery for the treatment of localized prostate cancer. Robotic surgery could be a therapeutic option. We try to evaluate both techniques, analyzing a series of parameters that allow us to describe the advantages and disadvantages of both techniques.
We performed a MEDLINE search and reviewed the main series of laparoscopic radical prostatectomy (LRP) and robotic radical prostatectomy (RRP). The parameters analyzed for each techniques were: oncological results, functional results, blood loss, transfusion rates, surgical times, complications rates, learning curve and cost.
Both techniques have the advantage of being minimally invasive, which results in better recovery and aesthetic results. The learning curve of the robotic prostatectomy is shorter, 10 to 20 cases in comparison with 50 to 60 for the LRP. Cost analysis is more favourable for LRP, with a single-use instrument expenditure of 533 dollars per patient in comparison with 1.705 dollars with the robot. The cost of the robot is 1.200.000 dollars plus 100.000 dollars of annual maintenance (1). Operative time was 182 minutes [ 14 1-250] for robotic surgery and 234 min. [151-453] for LRP. Within the same institution, like Montsouris, times are very similar: 155 min. for the RRP and 18 1 min. for the (LRP). Mean operative blood loss was 234 ml [75-500] for the robot and 482 ml [185-859] for the LRP depending on the technique employed and the institution. Complication rate is similar for both techniques. The percentage of positive surgical margins is 20.6% for LRP and 19.24% for RRP Long term results on the biochemical PSA recurrence cannot be given due to the short life of both techniques. Continence rates are 56-100% for LRP and 70-98% for RRP Potency rates are 25-82% for LRP and 79-100% for RRP It is difficult to evaluate hospital stay because it depends on the politics of the medical institutions; nevertheless, it seems there are not significant differences between techniques.
Introoperative and postoperative advantages are comparable with both techniques. Robotic prostatectomy has a shorter learning curve. Prospective studies with longer follow-up are necessary to compare oncological and functional results. The cost of LRP is lower than RRP.
腹腔镜手术已证明是治疗局限性前列腺癌的传统手术的良好替代方法。机器人手术可能是一种治疗选择。我们试图评估这两种技术，分析一系列参数，以便描述这两种技术的优缺点。
我们进行了MEDLINE检索，并回顾了主要的腹腔镜根治性前列腺切除术（LRP）和机器人根治性前列腺切除术（RRP）系列研究。对每种技术分析的参数包括：肿瘤学结果、功能结果、失血量、输血率、手术时间、并发症发生率、学习曲线和成本。
两种技术都具有微创的优点，这导致更好的恢复和美观效果。机器人前列腺切除术的学习曲线较短，为10至20例，而LRP为50至60例。成本分析对LRP更有利，一次性器械费用为每位患者533美元，而机器人手术为1705美元。机器人的成本为120万美元加上每年10万美元的维护费用（1）。机器人手术的手术时间为182分钟[141 - 250]，LRP为234分钟[151 - 453]。在同一机构，如蒙苏里，时间非常相似：RRP为155分钟，LRP为181分钟。根据所采用的技术和机构不同，机器人手术的平均术中失血量为234毫升[75 - 500]，LRP为482毫升[185 - 859]。两种技术的并发症发生率相似。LRP的手术切缘阳性率为20.6%，RRP为19.24%。由于这两种技术应用时间较短，无法给出关于生化前列腺特异抗原复发的长期结果。LRP的控尿率为56 - 100%，RRP为70 - 98%。LRP的性功能恢复率为25 - 82%，RRP为79 - 100%。由于这取决于医疗机构的政策，很难评估住院时间；然而，两种技术之间似乎没有显著差异。
两种技术的术中和术后优点相当。机器人前列腺切除术的学习曲线较短。需要进行更长随访时间的前瞻性研究来比较肿瘤学和功能结果。LRP的成本低于RRP。
