Andrew Fuller1, Stephen E Pautler2. 1. Division of Urology, Department of Surgery, Schulich School of Medicine & Dentistry, Western University, London, ON; 2. Division of Urology, Department of Surgery, Schulich School of Medicine & Dentistry, Western University, London, ON; ; Division of Surgical Oncology, Department of Oncology, Schulich School of Medicine & Dentistry, Western University, London, ON.
Abstract
BACKGROUND: Robot-assisted radical prostatectomy (RARP) has emerged in the last decade as an alternative to open radical prostatectomy for men with localized prostate cancer. The increased cost of this technique has been justified by its ability to reduce blood loss, and to provide improved vision, less postoperative pain and more rapid recovery from surgery, while maintaining satisfactory oncological and functional outcomes. Given the increasing diffusion of robotic surgical technology within Canada and its associated high capital and operating costs, we review the clinical outcomes and complications from 305 consecutive cases performed at our Canadian institution. METHODS: A consecutive cohort of 305 patients with a mean follow-up of 30 months was analyzed with institutional ethics approval. All patients were treated and reviewed postoperatively by a single surgeon (SP). The primary aim of the study was to assess the incidence and type of complications associated with RARP in a Canadian setting. Our prospective database captured preoperative, intra-operative and postoperative data and was maintained by an individual independent of the robotic program. We report complications categorized according to the Clavien system. Multiple complications seen in an individual were recorded separately for the purposes of our analysis. RESULTS: Between April 2005 and October 2010, 305 patients underwent RARP at our institution. A total of 70 complications were identified, with 47 (67.1%) requiring only conservative or pharmacological management (Clavien I-II). Twenty-three patients were found to have a major complication (Clavien III-V). Of the 16 who required intervention under general anesthesia, 3 required emergency treatment and the remaining patients underwent elective surgery. CONCLUSIONS: RARP has been incorporated at our institution with an acceptably low rate of intra-operative and postoperative complications. We have found that the database was effective in providing patients with outcome-related information, which in turn helped us gain patient consent with regard to the institution-specific risks of RARP.
BACKGROUND: Robot-assisted radical prostatectomy (RARP) has emerged in the last decade as an alternative to open radical prostatectomy for men with localized prostate cancer. The increased cost of this technique has been justified by its ability to reduce blood loss, and to provide improved vision, less postoperative pain and more rapid recovery from surgery, while maintaining satisfactory oncological and functional outcomes. Given the increasing diffusion of robotic surgical technology within Canada and its associated high capital and operating costs, we review the clinical outcomes and complications from 305 consecutive cases performed at our Canadian institution. METHODS: A consecutive cohort of 305 patients with a mean follow-up of 30 months was analyzed with institutional ethics approval. All patients were treated and reviewed postoperatively by a single surgeon (SP). The primary aim of the study was to assess the incidence and type of complications associated with RARP in a Canadian setting. Our prospective database captured preoperative, intra-operative and postoperative data and was maintained by an individual independent of the robotic program. We report complications categorized according to the Clavien system. Multiple complications seen in an individual were recorded separately for the purposes of our analysis. RESULTS: Between April 2005 and October 2010, 305 patients underwent RARP at our institution. A total of 70 complications were identified, with 47 (67.1%) requiring only conservative or pharmacological management (Clavien I-II). Twenty-three patients were found to have a major complication (Clavien III-V). Of the 16 who required intervention under general anesthesia, 3 required emergency treatment and the remaining patients underwent elective surgery. CONCLUSIONS: RARP has been incorporated at our institution with an acceptably low rate of intra-operative and postoperative complications. We have found that the database was effective in providing patients with outcome-related information, which in turn helped us gain patient consent with regard to the institution-specific risks of RARP.
Authors: Akshay Bhandari; Linda McIntire; Sanjeev A Kaul; Ashok K Hemal; James O Peabody; Mani Menon Journal: J Urol Date: 2005-09 Impact factor: 7.450
Authors: Jim C Hu; Rebecca A Nelson; Timothy G Wilson; Mark H Kawachi; S Adam Ramin; Clayton Lau; Laura E Crocitto Journal: J Urol Date: 2006-02 Impact factor: 7.450
Authors: Anthony V D'Amico; Richard Whittington; S Bruce Malkowicz; Kerri Cote; Marian Loffredo; Delray Schultz; Ming-Hui Chen; John E Tomaszewski; Andrew A Renshaw; Alan Wein; Jerome P Richie Journal: Cancer Date: 2002-07-15 Impact factor: 6.860
Authors: Brian Kim; Allen Chang; Jennifer Kaswick; Armen Derboghossians; Howard Jung; Jeff Slezak; Melanie Wuerstle; Stephen G Williams; Gary W Chien Journal: Can Urol Assoc J Date: 2013 Nov-Dec Impact factor: 1.862