Robotic assisted simple prostatectomy mitigates perioperative morbidity compared to open simple prostatectomy - a single institution report

Abstract

Abstract Background: European guidelines currently advocate to offer open simple prostatectomy to patients with a prostate volume above 80 mL who suffer from moderate to severe LUTS, if a transurethral enucleation technique cannot be provided. However, open simple prostatectomy is regarded as an invasive surgical method, which is associated with relatively high perioperative morbidity and longer hospital stays, when compared to minimally invasive procedures. The aim of the study was to compare perioperative data from the first 26 robotic assisted simple prostatectomy (RASP) cases to patients who were previously treated with open simple prostatectomy (OSP) at our department. Methods: The patients were identified by a search for the respective procedure codes. In the OSP group the prostatic adenoma was enucleated directly through the prostatic capsule (Millin procedure), while the adenoma was approached through the bladder in the RASP group. Complications between the groups were assessed by the Clavien-Dindo classification system. Results: 27 patients who previously were treated with OSP were identified and compared to the first 26 who underwent RASP. Bleeding volume was 585 ± 317 ml in the OSP group compared to 134 ± 73 ml in the RASP group (p<0.001), resulting in a larger drop in postoperative hemoglobin (3.5 ± 1.7 in the OSP group compared to 1.7 ± 1.1 in the RASP group, p<0.001). Blood transfusions were significantly higher in the OSP group (12) compared to the RASP group (none, p<0.05). Clavien-Dindo score of 2 or more within 30 days were higher in the OSP group (11) compared to the RASP group (none, p<0.001). The mean length of hospital stay was 5.5 days (range 2-18) in the OSP group compared to 1.6 days (range 1-5) in the RASP group (p<0.001). Conclusions: The introduction of robotic assisted simple prostatectomy reduced perioperative morbidity at our department.