title: Robotic-Assisted Versus Manual Prostatic Arterial Embolization for Benign Prostatic Hyperplasia: A Comparative Analysis.
abstract: OBJECTIVE
  Prostatic artery embolization (PAE) is a safe and efficacious procedure for benign prostatic hyperplasia (BPH), though is technically challenging. We present our experience of technical and clinical outcomes of robotic and manual PAE in patients with BPH.
  
  
  METHODS
  IRB-approved retrospective study of 40 consecutive patients 49-81 years old with moderate or severe grade BPH from May 2014 to July 2015: 20 robotic-assisted PAE (group 1), 20 manual PAE (group 2). Robotic-assisted PAE was performed using the Magellan Robotic System. American Urological Association (AUA-SI) score, cost, technical and clinical success, radiation dose, fluoroscopy, and procedure time were reviewed. Statistical analysis was performed within and between each group using paired t test and one-way analysis of variance respectively, at 1 and 3 months.
  
  
  RESULTS
  No significant baseline differences in age and AUA-SI between groups. Technical success was 100% (group 1) and 95% (group 2). One unsuccessful subject from group 2 returned for a successful embolization using robotic assistance. Fluoroscopy and procedural times were similar between groups, with a non-significant lower patient radiation dose in group 1 (30,632.8 mGy/cm2vs 35,890.9, p = 0.269). Disposable cost was significantly different between groups with the robotic-assisted PAE incurring a higher cost (group 1 $4530.2; group 2 $1588.5, p < 0.0001). Clinical improvement was significant in both arms at 3 months: group 1 mean change in AUA-SI of 8.3 (p = 0.006), group 2: 9.6 (p < 0.0001). No minor or major complications occurred.
  
  
  CONCLUSIONS
  Robotic-assisted PAE offers technical success comparable to manual PAE, with similar clinical improvement with an increased cost.
authors.affiliation: Vascular Institute of Virginia, LLC, 14085 Crown Ct., Woodbridge, VA, 22193, USA. sandeep.bagla@gmail.com.
authors.forename: Sandeep
authors.initials: S
authors.lastname: Bagla
authors.affiliation: New York Presbyterian Hospital/Weill Cornell Medical Center, New York, NY, USA.
authors.forename: John
authors.initials: J
authors.lastname: Smirniotopoulos
authors.affiliation: Vascular Institute of Virginia, LLC, 14085 Crown Ct., Woodbridge, VA, 22193, USA.
authors.forename: Julie C
authors.initials: JC
authors.lastname: Orlando
authors.affiliation: Vascular Institute of Virginia, LLC, 14085 Crown Ct., Woodbridge, VA, 22193, USA.
authors.forename: Rachel
authors.initials: R
authors.lastname: Piechowiak
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D004621:Embolization, Therapeutic / Q000295:instrumentation* / Q000379:methods*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011467:Prostate / Q000098:blood supply; D011470:Prostatic Hyperplasia / Q000628:therapy*; D012189:Retrospective Studies; D012371:Robotics / Q000379:methods*; D013997:Time Factors; D016896:Treatment Outcome
keywords: Benign prostatic hyperplasia; Prostatic artery embolization; Robotic