title: Is robotically assisted laparoscopic radical prostatectomy less invasive than retropubic radical prostatectomy? Results from a prospective, unrandomized, comparative study.
abstract: OBJECTIVE
  To evaluate whether robotically assisted laparoscopic prostatectomy (RALP) is less invasive than radical retropubic prostatectomy (RRP), as experimental studies suggest that the acute phase reaction is proportional to surgery-induced tissue damage.
  
  
  METHODS
  Between May and November 2006, all patients undergoing RRP or RALP in our department were prospectively assessed. Blood samples were collected 24 h before (T0), during surgery (T1), at the end of anaesthesia (T2), and 12 (T3) and 24 h after surgery (T4), and assayed for interleukin(IL)-6 and IL-1 alpha, C-reactive protein (CRP), and lactate. The Mann-Whitney U-, Student's t- and Friedman tests were used to compare continuous variables, and the Pearson chi-square and Fisher test for categorical variables, with a two-sided P < 0.05 considered to indicate significance.
  
  
  RESULTS
  In all, 35 and 26 patients were assessed for RALP and RRP, respectively; the median (interquartile range) age was 62 (56-68) and 68.5 (59.2-71.2) years, respectively (P < 0.009). Baseline levels (T0) of IL-1, IL-6, CRP and lactate were comparable in both arms. IL-6, CRP and lactates levels increased during both kinds of surgery. The mean IL-6 and CPR values were higher for RRP at T1 (P = 0.01 and 0.001), T2 (P = 0.001 and <0.001), T3 (P = 0.002 and <0.001) and T4 (P < 0.001 and 0.02), respectively. Lactate was higher for RRP at T2 (P = 0.001), T3 (P = 0.001) and T4 (P = 0.004), although remaining within the normal ranges. IL-1 alpha did not change at the different sample times.
  
  
  CONCLUSIONS
  This study showed for the first time that RALP induces lower tissue trauma than RRP.
authors.affiliation: Department of Oncological and Surgical Sciences, Urology Clinic, University of Padua, Italy.
authors.forename: Simonetta
authors.initials: S
authors.lastname: Fracalanza
authors.forename: Vincenzo
authors.initials: V
authors.lastname: Ficarra
authors.forename: Stefano
authors.initials: S
authors.lastname: Cavalleri
authors.forename: Antonio
authors.initials: A
authors.lastname: Galfano
authors.forename: Giacomo
authors.initials: G
authors.lastname: Novara
authors.forename: Angelo
authors.initials: A
authors.lastname: Mangano
authors.forename: Mario
authors.initials: M
authors.lastname: Plebani
authors.forename: Walter
authors.initials: W
authors.lastname: Artibani
mesh_terms: D000210:Acute-Phase Reaction / Q000517:prevention & control*; D000368:Aged; D002097:C-Reactive Protein / Q000032:analysis; D006801:Humans; D053582:Interleukin-1alpha / Q000097:blood; D015850:Interleukin-6 / Q000097:blood; D019344:Lactic Acid / Q000097:blood; D010535:Laparoscopy; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000517:prevention & control*; D011446:Prospective Studies; D011468:Prostatectomy / Q000009:adverse effects / Q000379:methods*; D011471:Prostatic Neoplasms / Q000097:blood / Q000601:surgery*; D012371:Robotics; D018709:Statistics, Nonparametric; D016896:Treatment Outcome
chemical_list: D053582:Interleukin-1alpha; D015850:Interleukin-6; D019344:Lactic Acid; D002097:C-Reactive Protein