Comparison of transfusion requirements between open and robotic-assisted laparoscopic radical prostatectomy.
OBJECTIVE
To determine whether robotic-assisted laparoscopic radical prostatectomy (RALP) is associated with a lower transfusion rate than radical retropubic prostatectomy (RRP).


METHODS
In this cohort study, we evaluated 1244 consecutive patients who underwent RALP (830) or RRP (414) between June 2003 and July 2006. Demographics, clinical characteristics, pathology, blood loss and transfusion data were collected prospectively. Groups were compared for baseline characteristics, blood loss, change in haematocrit and transfusion using univariate statistics, and an exploratory multivariate model was developed.


RESULTS
RALP was associated with lower blood loss (median 100 vs 450 mL, P < 0.001) and a smaller change in haematocrit (median 7% vs 10%, P < 0.001) than RRP. Although both groups had low transfusion rates, the RALP group required fewer transfusions than the RRP group (0.8% vs 3.4%, P= 0.002). On univariate analysis, surgical approach (RRP vs RALP), estimated blood loss ≥500 mL and change in haematocrit ≥10% were the only the significant predictors of transfusion. In the exploratory multivariate model RALP was the only significant predictor of reduced need for transfusion, with an odds ratio of 0.23 (95% confidence interval 0.09-0.58; P= 0.002).


CONCLUSIONS
This study shows that RALP is associated not only with less blood loss and a smaller decrease in haematocrit, but also a decreased need for transfusion.
Vanderbilt University Medical Center, Department of Urologic Surgery, Nashville, TN 37205, USA.
Yakup
Y
Kordan
Daniel A
DA
Barocas
Hernan O
HO
Altamar
Peter E
PE
Clark
Sam S
SS
Chang
Rodney
R
Davis
S Duke
SD
Herrell
Roxy
R
Baumgartner
Vineet
V
Mishra
Robert C
RC
Chan
Joseph A
JA
Smith
Michael S
MS
Cookson
D016063:Blood Loss, Surgical / Q000706:statistics & numerical data*; D001803:Blood Transfusion / Q000706:statistics & numerical data*; D015331:Cohort Studies; D006400:Hematocrit / Q000706:statistics & numerical data; D006801:Humans; D010535:Laparoscopy; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D011468:Prostatectomy / Q000379:methods*; D011471:Prostatic Neoplasms / Q000601:surgery*; D012371:Robotics