Bristol Urological Institute, Southmead Hospital, North Bristol NHS Trust, Bristol, United Kingdom.
J Endourol. 2012 Aug;26(8):1002-8. doi: 10.1089/end.2011.0569. Epub 2012 Apr 30.
Because of the increased use of robot-assisted laparoscopic prostatectomy (RALP) for the management of localized prostate cancer, surgeons in training face the issues of developing skills in both open surgery and the robotic console. This study compares prospectively the safety and efficacy of the first 50 open radical retropubic prostatectomy (RRP) procedures and the first 50 RALP procedures, performed by the same surgeon in the same institution.
The patients' baseline demographic, clinical, and oncologic parameters were prospectively recorded. The study end points included oncologic outcome, functional outcomes (at 3 months), and perioperative parameters. Complications were classified according to the modified Clavien system.
No statistically significant differences were noted between the two groups in terms of preoperative patient characteristics and oncologic parameters. The operative time and mean estimated blood loss were lower in the RALP group (P<0.001), but no statistically significant difference was noted in regard to transfusion rates (P=0.362). Mean hospital stay was lower in the RALP group (P<0.001). The minor (Clavien I+II) and major (Clavien III+IV) complication rates were comparable between the two groups. The overall positive margin (PSM) rates were 20% and 18% for RRP and RALP, respectively (P=0.799), while for pT(3) disease, the PSM rates were 26.1% and 22.2%% for RRP and RALP, respectively (P=0.53). The 3-month continence rates were 88% and 90% for RRP and RALP, respectively (P=0.749). For preoperatively potent patients, 3-month potency rates were comparable between the two groups (60.6% and 62.1% in the RRP and the RALP group, respectively, P=0.893).
The early learning curve for RALP appears safe and results in equivalent functional and oncologic outcome, when compared with the results of open surgery.
由于机器人辅助腹腔镜前列腺切除术（RALP）在局部前列腺癌治疗中的应用日益增多，受训外科医生面临着在开放手术和机器人控制台两方面发展技能的问题。本研究前瞻性比较了同一位外科医生在同一机构完成的前 50 例开放式根治性前列腺切除术（RRP）和前 50 例 RALP 手术的安全性和疗效。
前瞻性记录患者的基线人口统计学、临床和肿瘤学参数。研究终点包括肿瘤学结果、功能结果（术后 3 个月）和围手术期参数。并发症根据改良的 Clavien 系统分类。
两组患者术前特征和肿瘤学参数无统计学差异。RALP 组手术时间和平均估计失血量较低（P<0.001），但输血率无统计学差异（P=0.362）。RALP 组平均住院时间较低（P<0.001）。两组 minor（Clavien I+II）和 major（Clavien III+IV）并发症发生率相似。总体阳性切缘（PSM）率分别为 RRP 组和 RALP 组的 20%和 18%（P=0.799），而对于 pT（3）疾病，PSM 率分别为 RRP 组和 RALP 组的 26.1%和 22.2%（P=0.53）。RRP 和 RALP 的 3 个月控尿率分别为 88%和 90%（P=0.749）。对于术前有性功能的患者，两组 3 个月的勃起功能相似（RRP 组为 60.6%，RALP 组为 62.1%，P=0.893）。
与开放手术相比，RALP 的早期学习曲线似乎是安全的，并且在功能和肿瘤学结果方面相当。
