Is robotically assisted laparoscopic radical prostatectomy less invasive than retropubic radical prostatectomy? Results from a prospective, unrandomized, comparative study.
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.
Fracalanza
Simonetta
S
Department of Oncological and Surgical Sciences, Urology Clinic, University of Padua, Italy.
Ficarra
Vincenzo
V
Cavalleri
Stefano
S
Galfano
Antonio
A
Novara
Giacomo
G
Mangano
Angelo
A
Plebani
Mario
M
Artibani
Walter
W
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
D053582:Interleukin-1alpha; D015850:Interleukin-6; D019344:Lactic Acid; D002097:C-Reactive Protein