Radical prostatectomy: a single surgeon comparison of retropubic, perineal, and robotic approaches.
OBJECTIVE
To compare perioperative, functional and oncological outcomes of a single surgeon's experience with retropubic (RRP), perineal (RPP), and robotic assisted (RARP) radical prostatectomy.


METHODS
Results from 150 radical prostatectomies performed by a single surgeon were compared. The groups consisted of the last 50 consecutive RRP (group 1) and RPP patients (group 2) and his first 50 RARP patients (group 3). He had significant experience in RRP and RPP and extensive training prior to performing RARP. The data was obtained from record review and patient survey. Patient demographics, operative parameters, pathological characteristics, complications, and functional outcomes were compared between groups.


RESULTS
The groups were comparable with respect to patient demographics. Hospital stay, blood loss, and transfusion requirements were significantly better in the robotic group. Complications were least in the robotic group. Urinary continence (one pad or less) at 12 months was 96% in RRP, 96% in RPP, and 96% in RARP group. Positive surgical margins in organ confined disease were significantly lower for RARP although overall positive margins were similar. Potency data was still maturing and was not included in this analysis.


CONCLUSIONS
There were no major differences in outcomes between the RRP and RPP groups. The RARP group had equal or better perioperative outcomes in all analyzed categories with the least complications. Urinary function outcomes were excellent in all groups. Prior open experience and extensive training facilitate encouraging outcomes for robotic prostatectomy even in a surgeon's initial series of patients.
Boris
Ronald S
RS
Vatikutti Urology Institute, Henry Ford Health System, Detroit, Michigan 48202, USA.
Kaul
Sanjeev A
SA
Sarle
Richard C
RC
Stricker
Hans J
HJ
D000328:Adult; D000368:Aged; D016063:Blood Loss, Surgical; D001803:Blood Transfusion / Q000706:statistics & numerical data; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D010502:Perineum; D011183:Postoperative Complications; D011468:Prostatectomy / Q000295:instrumentation / Q000379:methods*; D011471:Prostatic Neoplasms / Q000473:pathology / Q000601:surgery*; D011630:Pubic Bone; D012371:Robotics; D016896:Treatment Outcome