[Retropubic, laparoscopic and robot-assisted total prostatectomies: comparison of postoperative course and histological and functional results based on a series of 86 prostatectomies].
OBJECTIVE
Compare three surgical approach procedures of total prostatectomy (retropubic, transperitoneal laparoscopic and robot-assisted laparoscopic), about technical, oncological and functional results.


METHODS
Eighty-six patients had a total prostatectomy for localized cancer, in a unique center, performed by two expert surgeons, on a 16-months-period. Twenty nine had a retropubic, 23 a transperitoneal laparoscopic and 34 a robot-assisted (Da Vinci) surgical approach. Retrospectively, operative time, blood loss, per- and postoperative complications, duration of catheterization, length of hospital stay, in each group had been compared. The positive margin rates, the PSA levels at one and six months postoperative had been compared. The continence has also been evaluated at six months.


RESULTS
The three groups are comparable even if the median age is significatively lower in the retropubic group (p=0.018). Duration of catheter (p<2.2 x 10(-16)), blood loss (p<3.12 x 10(-5)) and operative times support significatively the laparscopic approaches, clearer the conventional than the robot-assisted one. No significative difference has been shown about positive margin rates, even if it's higher in the robot-assisted group (p=0.37). Finally, the continence rate is quite higher in the laparoscopic groups without statistic significativity (76 % retropubic versus 96.8 % laparoscopic and 85.3 % robot-assisted).


CONCLUSIONS
The conventional laparoscopic and robot-assisted approaches seem to present technical advantages. Nevertheless, pathologic results are shader: the positive margin rate in the robot-assisted group is higher, in particular regarding to pT2. These results are concordant with the available datas of the literature.
Durand
X
X
Service d'urologie et transplantation rénale, GHU, Pitié-Salpêtrière, 47-83, boulevard-de-l'Hôpital, 75651 Paris cedex 13, France. xavierdurand-urovdg@tiscali.fr <xavierdurand-urovdg@tiscali.fr>
Vaessen
C
C
Bitker
M-O
MO
Richard
F
F
D000368:Aged; D006801:Humans; D010535:Laparoscopy / Q000009:adverse effects; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000453:epidemiology; D011468:Prostatectomy / Q000009:adverse effects* / Q000379:methods*; D012189:Retrospective Studies; D012371:Robotics; D016896:Treatment Outcome; D014546:Urinary Catheterization / Q000379:methods; D014549:Urinary Incontinence / Q000453:epidemiology