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Whats Better…A Human doing the Surgery or a Robot?

A comparative study of robot‐assisted and open radical prostatectomy in 10,790 men treated by highly trained surgeons for both procedures

 

First published: 29 March 2019

This article has been accepted for publication and undergone full peer review but has not been through the copyediting, typesetting, pagination and proofreading process, which may lead to differences between this version and the Version of Record.

Objective

To compare oncological, functional and surgical outcomes of open retropubic radical prostatectomy (ORP) vs. robot‐assisted laparoscopic radical prostatectomy (RARP).

Patients and Methods

We identified 10,790 consecutive treated patients within our prospective database (2008‐2016) who underwent either ORP (n=7,007) or RARP (n=3,783). All procedures were performed by seven highly trained surgeons performing both surgical approaches regularly. Oncological (48‐month biochemical recurrence rate [BCR]), functional (urinary continence, erectile function) and surgical outcomes (rate of nerve‐sparing procedures, lymph node yield, surgical margin status, length of hospital stay, operation time, blood loss, transfusion rate, time to catheter removal) were assessed. Kaplan‐Meier, multivariable Cox and logistic regression models were used to test for BCR and functional outcome differences.

Results

No statistically significant difference regarding oncological outcome distinguished between ORP vs. RARP. Regarding functional outcomes, one‐week continence rates were higher in ORP (25.8% vs. 21.8%, p<0.001). At three months, no statistically significant differences were observed. At one year, continence rates were modestly higher in RARP (90.3% vs. 88.8%, p=0.01). This effect was no longer observed after stratification for age‐groups. One‐year potency rates were similar in ORP vs. RARP (80.3% vs. 83.6%, p=0.33). Regarding surgical outcomes, no significant difference was observed in rates of nerve‐sparing procedures, lymph node yield, surgical margin status, and length of hospital stay. Conversely, operation time was shorter in ORP, and blood loss, transfusion rates and time to catheter removal were significantly lower in RARP.

Conclusions

Both surgical approaches, performed in a high‐volume center by the same surgeons, achieve excellent, comparable oncological and functional outcomes. However, a modest advantage for RARP regarding surgical outcomes was observed, most likely attributable to its minimally invasive nature, and better teaching capabilities. In consequence, more than the surgical approach itself, the well‐trained surgeon remains the most important factor to achieve satisfactory outcomes.

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