title: Short-term results after robot-assisted laparoscopic radical prostatectomy compared to open radical prostatectomy.
abstract: BACKGROUND
  Robot-assisted laparoscopic radical prostatectomy has become a widespread technique despite a lack of randomised trials showing its superiority over open radical prostatectomy.
  
  
  OBJECTIVE
  To compare in-hospital characteristics and patient-reported outcomes at 3 mo between robot-assisted laparoscopic and open retropubic radical prostatectomy.
  
  
  METHODS
  A prospective, controlled trial was performed of all men who underwent radical prostatectomy at 14 participating centres. Validated patient questionnaires were collected at baseline and after 3 mo by independent health-care researchers.
  
  
  METHODS
  The difference in outcome between the two treatment groups were analysed using logistic regression analysis, with adjustment for identified confounders.
  
  
  CONCLUSIONS
  Questionnaires were received from 2506 (95%) patients. The robot-assisted surgery group had less perioperative bleeding (185 vs 683 ml, p<0.001) and shorter hospital stay (3.3 vs 4.1 d, p<0.001) than the open surgery group. Operating time was shorter with the open technique (103 vs 175 min, p<0.001) compared with the robot-assisted technique. Reoperation during initial hospital stay was more frequent after open surgery after adjusting for tumour characteristics and lymph node dissection (1.6% vs 0.7%, odds ratio [OR] 0.31, 95% confidence interval [CI 95%] 0.11-0.90). Men who underwent open surgery were more likely to seek healthcare (for one or more of 22 specified disorders identified prestudy) compared to men in the robot-assisted surgery group (p=0.03). It was more common to seek healthcare for cardiovascular reasons in the open surgery group than in the robot-assisted surgery group, after adjusting for nontumour and tumour-specific confounders, (7.9% vs 5.8%, OR 0.63, CI 95% 0.42-0.94). The readmittance rate was not statistically different between the groups. A limitation of the study is the lack of a standardised tool for the assessment of the adverse events.
  
  
  CONCLUSIONS
  This large prospective study confirms previous findings that robot-assisted laparoscopic radical prostatectomy is a safe procedure with some short-term advantages compared to open surgery. Whether these advantages also include long-term morbidity and are related to acceptable costs remain to be studied.
  
  
  RESULTS
  We compare patient-reported outcomes between two commonly used surgical techniques. Our results show that the choice of surgical technique may influence short-term outcomes.
authors.affiliation: Department of Molecular Medicine and Surgery, Section of Urology, Karolinska Institutet, Solna, Stockholm, Sweden. Electronic address: anna.wallerstedt@karolinska.se.
authors.forename: Anna
authors.initials: A
authors.lastname: Wallerstedt
authors.affiliation: Department of Molecular Medicine and Surgery, Section of Urology, Karolinska Institutet, Solna, Stockholm, Sweden.
authors.forename: Stavros I
authors.initials: SI
authors.lastname: Tyritzis
authors.affiliation: Division of Clinical Cancer Epidemiology, Department of Oncology, Institute of Clinical Sciences, Sahlgrenska Academy at the University of Gothenburg, Gothenburg, Sweden; Faculty of Nursing, School of Health Sciences, University of Iceland, Reykjavik, Iceland.
authors.forename: Thordis
authors.initials: T
authors.lastname: Thorsteinsdottir
authors.affiliation: Department of Molecular Medicine and Surgery, Section of Urology, Karolinska Institutet, Solna, Stockholm, Sweden.
authors.forename: Stefan
authors.initials: S
authors.lastname: Carlsson
authors.affiliation: Department of Urology, Institute of Clinical Sciences, Sahlgrenska Academy at the University of Gothenburg, Sahlgrenska University Hospital, Gothenburg, Sweden.
authors.forename: Johan
authors.initials: J
authors.lastname: Stranne
authors.affiliation: Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Solna, Stockholm, Sweden.
authors.forename: Ove
authors.initials: O
authors.lastname: Gustafsson
authors.affiliation: Department of Urology, Institute of Clinical Sciences, Sahlgrenska Academy at the University of Gothenburg, Sahlgrenska University Hospital, Gothenburg, Sweden.
authors.forename: Jonas
authors.initials: J
authors.lastname: Hugosson
authors.affiliation: Department of Urology, Skåne University Hospital, Lund University, Lund, Sweden.
authors.forename: Anders
authors.initials: A
authors.lastname: Bjartell
authors.affiliation: Division of Clinical Cancer Epidemiology, Department of Oncology, Institute of Clinical Sciences, Sahlgrenska Academy at the University of Gothenburg, Gothenburg, Sweden.
authors.forename: Ulrica
authors.initials: U
authors.lastname: Wilderäng
authors.affiliation: Department of Molecular Medicine and Surgery, Section of Urology, Karolinska Institutet, Solna, Stockholm, Sweden.
authors.forename: N Peter
authors.initials: NP
authors.lastname: Wiklund
authors.affiliation: Division of Clinical Cancer Epidemiology, Department of Oncology, Institute of Clinical Sciences, Sahlgrenska Academy at the University of Gothenburg, Gothenburg, Sweden; Department of Oncology and Pathology, Division of Clinical Cancer Epidemiology, Karolinska Institutet, Solna, Stockholm, Sweden.
authors.forename: Gunnar
authors.initials: G
authors.lastname: Steineck
authors.affiliation: Department of Surgery, Institute of Clinical Sciences, Sahlgrenska Academy at the University of Gothenburg, Gothenburg, Sweden.
authors.forename: Eva
authors.initials: E
authors.lastname: Haglind
mesh_terms: D000368:Aged; D006801:Humans; D010535:Laparoscopy / Q000295:instrumentation* / Q000379:methods; D007902:Length of Stay / Q000706:statistics & numerical data; D008197:Lymph Node Excision / Q000379:methods*; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D011446:Prospective Studies; D011467:Prostate / Q000473:pathology / Q000601:surgery*; D011468:Prostatectomy / Q000295:instrumentation* / Q000379:methods; D011471:Prostatic Neoplasms / Q000473:pathology / Q000601:surgery*; D012044:Regression Analysis; D012086:Reoperation / Q000706:statistics & numerical data; D012371:Robotics / Q000295:instrumentation*; D013997:Time Factors; D016896:Treatment Outcome
keywords: Complications; Open; Radical prostatectomy; Robot-assisted; Short-term results