Robotic technology and the translation of open radical prostatectomy to laparoscopy: the early Frankfurt experience with robotic radical prostatectomy and one year follow-up.
OBJECTIVE
Laparoscopic radical prostatectomy is a complex procedure and has been standardized only during the last years. The remote controlled da Vinci Surgical System has opened up a new era in minimally invasive surgery. We here present our initial experience with the translation of open retropubic radical prostatectomy to laparoscopic technique using da Vinci and a one year follow-up.


METHODS
After a period of technical development and training on cadavers, 40 consecutive patients eligible for radical prostatectomy were treated. After port placement, the urologist took control of the 3D 30 degrees laparoscope and the two instrument arms at the da Vinci remote console to perform bilateral pelvic lymph node dissection, radical prostatovesiculectomy and urethrovesical anastomosis.


RESULTS
The procedure was completed laparoscopically in all but two patients. Mean procedure time was 8.3 hours and mean intra-operative blood loss 570 ml. Learning curves associated with the use of the da Vinci Surgical System show that there is a 22-minute decrease in time required to perform the radical prostatectomy and lymphadenectomy for each case (p<0.0001). Patients recovered rapidly after surgery with early oncological and functional results that were similar to those obtained with our standard radical prostatectomy technique.


CONCLUSIONS
Remote controlled robotic surgical systems are useful to translate open retropubic radical prostatectomy to laparoscopy. This new technology has the potential to equip the urologist with the microsurgical precision needed to preserve the delicate structural integrity of the pelvic floor in order to improve functional results without compromising the oncological outcome.
Bentas
Wassilios
W
Department of Urology and Pediatric Urology, J.W. Goethe University of Frankfurt, University Hospital Frankfurt am Main, Theodor-Stern-Kai 7, D-60590 Frankfurt am Main, Germany. bentas@em.uni-frankfurt.de
Wolfram
Marc
M
Jones
Jon
J
Bräutigam
Ronald
R
Kramer
Wolfgang
W
Binder
Jochen
J
D000368:Aged; D016063:Blood Loss, Surgical; D019074:Epigastric Arteries / Q000293:injuries; D007172:Erectile Dysfunction / Q000209:etiology; D005500:Follow-Up Studies; D006488:Hemostasis, Surgical; D006801:Humans; D010535:Laparoscopy / Q000009:adverse effects / Q000379:methods*; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D009776:Obturator Nerve / Q000293:injuries; D010043:Outcome and Process Assessment, Health Care; D011183:Postoperative Complications; D017430:Prostate-Specific Antigen / Q000097:blood; D011468:Prostatectomy / Q000009:adverse effects / Q000379:methods*; D011471:Prostatic Neoplasms / Q000097:blood / Q000473:pathology / Q000601:surgery*; D011655:Pulmonary Embolism / Q000209:etiology; D012371:Robotics / Q000379:methods*; D013997:Time Factors; D014549:Urinary Incontinence / Q000209:etiology; D014552:Urinary Tract Infections / Q000209:etiology; D020246:Venous Thrombosis / Q000209:etiology
D017430:Prostate-Specific Antigen