title: Pitfalls of robot-assisted radical prostatectomy: a comparison of positive surgical margins between robotic and laparoscopic surgery.
abstract: OBJECTIVE
  To compare the surgical outcomes of laparoscopic radical prostatectomy and robot-assisted radical prostatectomy, including the frequency and location of positive surgical margins.
  
  
  METHODS
  The study cohort comprised 708 consecutive male patients with clinically localized prostate cancer who underwent laparoscopic radical prostatectomy (n = 551) or robot-assisted radical prostatectomy (n = 157) between January 1999 and September 2012. Operative time, estimated blood loss, complications, and positive surgical margins frequency were compared between laparoscopic radical prostatectomy and robot-assisted radical prostatectomy.
  
  
  RESULTS
  There were no significant differences in age or body mass index between the laparoscopic radical prostatectomy and robot-assisted radical prostatectomy patients. Prostate-specific antigen levels, Gleason sum and clinical stage of the robot-assisted radical prostatectomy patients were significantly higher than those of the laparoscopic radical prostatectomy patients. Robot-assisted radical prostatectomy patients suffered significantly less bleeding (P < 0.05). The overall frequency of positive surgical margins was 30.6% (n = 167; 225 sites) in the laparoscopic radical prostatectomy group and 27.5% (n = 42; 58 sites) in the robot-assisted radical prostatectomy group. In the laparoscopic radical prostatectomy group, positive surgical margins were detected in the apex (52.0%), anterior (5.3%), posterior (5.3%) and lateral regions (22.7%) of the prostate, as well as in the bladder neck (14.7%). In the robot-assisted radical prostatectomy patients, they were observed in the apex, anterior, posterior, and lateral regions of the prostate in 43.0%, 6.9%, 25.9% and 15.5% of patients, respectively, as well as in the bladder neck in 8.6% of patients.
  
  
  CONCLUSIONS
  Positive surgical margin distributions after robot-assisted radical prostatectomy and laparoscopic radical prostatectomy are significantly different. The only disadvantage of robot-assisted radical prostatectomy is the lack of tactile feedback. Thus, the robotic surgeon needs to take this into account to minimize the risk of positive surgical margins.
authors.affiliation: Department of Nephro-urology, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan.
authors.forename: Keiichi
authors.initials: K
authors.lastname: Tozawa
authors.forename: Takahiro
authors.initials: T
authors.lastname: Yasui
authors.forename: Yukihiro
authors.initials: Y
authors.lastname: Umemoto
authors.forename: Kentaro
authors.initials: K
authors.lastname: Mizuno
authors.forename: Atsushi
authors.initials: A
authors.lastname: Okada
authors.forename: Noriyasu
authors.initials: N
authors.lastname: Kawai
authors.forename: Satoru
authors.initials: S
authors.lastname: Takahashi
authors.forename: Kenjiro
authors.initials: K
authors.lastname: Kohri
mesh_terms: D000328:Adult; D000368:Aged; D016063:Blood Loss, Surgical; D015331:Cohort Studies; D006801:Humans; D010535:Laparoscopy / Q000009:adverse effects; D008297:Male; D008875:Middle Aged; D018365:Neoplasm, Residual; D061646:Operative Time; D011468:Prostatectomy / Q000009:adverse effects / Q000379:methods*; D011471:Prostatic Neoplasms / Q000473:pathology / Q000601:surgery*; D065287:Robotic Surgical Procedures / Q000009:adverse effects
keywords: laparoscopic radical prostatectomy; positive surgical margin; prostate cancer; retropubic radical prostatectomy; robot-assisted laparoscopic radical prostatectomy