Perioperative outcomes of robotic and laparoscopic simple prostatectomy

A european-American multi-institutional analysis

Riccardo Autorino, Homayoun Zargar, Mirandolino B. Mariano, Rafael Sanchez-Salas, René J. Sotelo, Piotr L. Chlosta, Octavio Castillo, Deliu V. Matei, Antonio Celia, Gokhan Koc, Anup Vora, Monish Aron, J. Kellogg Parsons, Giovannalberto Pini, James C. Jensen, Douglas Sutherland, Xavier Cathelineau, Luciano A.Nunez Bragayrac, Ioannis M. Varkarakis, Daniele Amparore & 34 others Matteo Ferro, Gaetano Gallo, Alessandro Volpe, Hakan Vuruskan, Gaurav Bandi, Jonathan Hwang, Josh Nething, Nic Muruve, Sameer Chopra, Nishant D. Patel, Ithaar Derweesh, David Champ Weeks, Ryan Spier, Keith Kowalczyk, John Lynch, Andrew Harbin, Mohan Verghese, Srinivas Samavedi, Wilson R. Molina, Emanuel Dias, Youness Ahallal, Humberto Laydner, Edward Cherullo, Ottavio De Cobelli, David D. Thiel, Mikael Lagerkvist, Georges Pascal Haber, Jihad Kaouk, Fernando J. Kim, Estevao Lima, Vipul Patel, Wesley White, Alexander Mottrie, Francesco Porpiglia

Research output: Contribution to journalArticle

47 Citations (Scopus)

Abstract

Background: Laparoscopic and robotic simple prostatectomy (SP) have been introduced with the aim of reducing the morbidity of the standard open technique. Objective: To report a large multi-institutional series of minimally invasive SP (MISP). Design, setting, and participants: Consecutive cases of MISP done for the treatment of bladder outlet obstruction (BOO) due to benign prostatic enlargement (BPE) between 2000 and 2014 at 23 participating institutions in the Americas and Europe were included in this retrospective analysis. Intervention: Laparoscopic or robotic SP. Outcome measurements and statistical analysis: Demographic data and main perioperative outcomes were gathered and analyzed. A multivariable analysis was conducted to identify factors associated with a favorable trifecta outcome, arbitrarily defined as a combination of the following postoperative events: International Prostate Symptom Score <8, maximum flow rate >15 ml/s, and no perioperative complications. Results and limitations: Overall, 1330 consecutive cases were analyzed, including 487 robotic (36.6%) and 843 laparoscopic (63.4%) SP cases. Median overall prostate volume was 100 ml (range: 89-128). Median estimated blood loss was 200 ml (range: 150-300). An intraoperative transfusion was required in 3.5% of cases, an intraoperative complication was recorded in 2.2% of cases, and the conversion rate was 3%. Median length of stay was 4 d (range: 3-5). On pathology, prostate cancer was found in 4% of cases. Overall postoperative complication rate was 10.6%, mostly of low grade. At a median follow-up of 12 mo, a significant improvement was observed for subjective and objective indicators of BOO. Trifecta outcome was not significantly influenced by the type of procedure (robotic vs laparoscopic; p = 0.136; odds ratio [OR]: 1.6; 95% confidence interval [CI], 0.8-2.9), whereas operative time (p = 0.01; OR: 0.9; 95% CI, 0.9-1.0) and estimated blood loss ( p = 0.03; OR: 0.9; 95% CI, 0.9-1.0) were the only two significant factors. Retrospective study design, lack of a control arm, and limited follow-up represent major limitations of the present analysis. Conclusions: This study provides the largest outcome analysis reported for MISP for BOO/BPE. These findings confirm that SP can be safely and effectively performed in a minimally invasive fashion in a variety of healthcare settings in which specific surgical expertise and technology is available. MISP can be considered a viable surgical treatment in cases of large prostatic adenomas. The use of robotic technology for this indication can be considered in centers that have a robotic program in place for other urologic indications. Patient summary: Analysis of a large data set from multiple institutions shows that surgical removal of symptomatic large prostatic adenomas can be carried out with good outcomes by using robot-assisted laparoscopy.

Original languageEnglish (US)
Pages (from-to)86-94
Number of pages9
JournalEuropean Urology
Volume68
Issue number1
DOIs
StatePublished - Jan 1 2015

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Robotics
Prostatectomy
Urinary Bladder Neck Obstruction
Odds Ratio
Prostatic Hyperplasia
Confidence Intervals
Prostate
Technology
Statistical Data Interpretation
Intraoperative Complications
Operative Time
Laparoscopy
Length of Stay
Prostatic Neoplasms
Retrospective Studies
Pathology
Morbidity
Delivery of Health Care
Therapeutics

All Science Journal Classification (ASJC) codes

  • Urology

Cite this

Autorino, R., Zargar, H., Mariano, M. B., Sanchez-Salas, R., Sotelo, R. J., Chlosta, P. L., ... Porpiglia, F. (2015). Perioperative outcomes of robotic and laparoscopic simple prostatectomy: A european-American multi-institutional analysis. European Urology, 68(1), 86-94. https://doi.org/10.1016/j.eururo.2014.11.044

Perioperative outcomes of robotic and laparoscopic simple prostatectomy : A european-American multi-institutional analysis. / Autorino, Riccardo; Zargar, Homayoun; Mariano, Mirandolino B.; Sanchez-Salas, Rafael; Sotelo, René J.; Chlosta, Piotr L.; Castillo, Octavio; Matei, Deliu V.; Celia, Antonio; Koc, Gokhan; Vora, Anup; Aron, Monish; Parsons, J. Kellogg; Pini, Giovannalberto; Jensen, James C.; Sutherland, Douglas; Cathelineau, Xavier; Bragayrac, Luciano A.Nunez; Varkarakis, Ioannis M.; Amparore, Daniele; Ferro, Matteo; Gallo, Gaetano; Volpe, Alessandro; Vuruskan, Hakan; Bandi, Gaurav; Hwang, Jonathan; Nething, Josh; Muruve, Nic; Chopra, Sameer; Patel, Nishant D.; Derweesh, Ithaar; Weeks, David Champ; Spier, Ryan; Kowalczyk, Keith; Lynch, John; Harbin, Andrew; Verghese, Mohan; Samavedi, Srinivas; Molina, Wilson R.; Dias, Emanuel; Ahallal, Youness; Laydner, Humberto; Cherullo, Edward; De Cobelli, Ottavio; Thiel, David D.; Lagerkvist, Mikael; Haber, Georges Pascal; Kaouk, Jihad; Kim, Fernando J.; Lima, Estevao; Patel, Vipul; White, Wesley; Mottrie, Alexander; Porpiglia, Francesco.

In: European Urology, Vol. 68, No. 1, 01.01.2015, p. 86-94.

Research output: Contribution to journalArticle

Autorino, R, Zargar, H, Mariano, MB, Sanchez-Salas, R, Sotelo, RJ, Chlosta, PL, Castillo, O, Matei, DV, Celia, A, Koc, G, Vora, A, Aron, M, Parsons, JK, Pini, G, Jensen, JC, Sutherland, D, Cathelineau, X, Bragayrac, LAN, Varkarakis, IM, Amparore, D, Ferro, M, Gallo, G, Volpe, A, Vuruskan, H, Bandi, G, Hwang, J, Nething, J, Muruve, N, Chopra, S, Patel, ND, Derweesh, I, Weeks, DC, Spier, R, Kowalczyk, K, Lynch, J, Harbin, A, Verghese, M, Samavedi, S, Molina, WR, Dias, E, Ahallal, Y, Laydner, H, Cherullo, E, De Cobelli, O, Thiel, DD, Lagerkvist, M, Haber, GP, Kaouk, J, Kim, FJ, Lima, E, Patel, V, White, W, Mottrie, A & Porpiglia, F 2015, 'Perioperative outcomes of robotic and laparoscopic simple prostatectomy: A european-American multi-institutional analysis', European Urology, vol. 68, no. 1, pp. 86-94. https://doi.org/10.1016/j.eururo.2014.11.044
Autorino, Riccardo ; Zargar, Homayoun ; Mariano, Mirandolino B. ; Sanchez-Salas, Rafael ; Sotelo, René J. ; Chlosta, Piotr L. ; Castillo, Octavio ; Matei, Deliu V. ; Celia, Antonio ; Koc, Gokhan ; Vora, Anup ; Aron, Monish ; Parsons, J. Kellogg ; Pini, Giovannalberto ; Jensen, James C. ; Sutherland, Douglas ; Cathelineau, Xavier ; Bragayrac, Luciano A.Nunez ; Varkarakis, Ioannis M. ; Amparore, Daniele ; Ferro, Matteo ; Gallo, Gaetano ; Volpe, Alessandro ; Vuruskan, Hakan ; Bandi, Gaurav ; Hwang, Jonathan ; Nething, Josh ; Muruve, Nic ; Chopra, Sameer ; Patel, Nishant D. ; Derweesh, Ithaar ; Weeks, David Champ ; Spier, Ryan ; Kowalczyk, Keith ; Lynch, John ; Harbin, Andrew ; Verghese, Mohan ; Samavedi, Srinivas ; Molina, Wilson R. ; Dias, Emanuel ; Ahallal, Youness ; Laydner, Humberto ; Cherullo, Edward ; De Cobelli, Ottavio ; Thiel, David D. ; Lagerkvist, Mikael ; Haber, Georges Pascal ; Kaouk, Jihad ; Kim, Fernando J. ; Lima, Estevao ; Patel, Vipul ; White, Wesley ; Mottrie, Alexander ; Porpiglia, Francesco. / Perioperative outcomes of robotic and laparoscopic simple prostatectomy : A european-American multi-institutional analysis. In: European Urology. 2015 ; Vol. 68, No. 1. pp. 86-94.
@article{acc13eda8d22447493d9d837355a6c02,
title = "Perioperative outcomes of robotic and laparoscopic simple prostatectomy: A european-American multi-institutional analysis",
abstract = "Background: Laparoscopic and robotic simple prostatectomy (SP) have been introduced with the aim of reducing the morbidity of the standard open technique. Objective: To report a large multi-institutional series of minimally invasive SP (MISP). Design, setting, and participants: Consecutive cases of MISP done for the treatment of bladder outlet obstruction (BOO) due to benign prostatic enlargement (BPE) between 2000 and 2014 at 23 participating institutions in the Americas and Europe were included in this retrospective analysis. Intervention: Laparoscopic or robotic SP. Outcome measurements and statistical analysis: Demographic data and main perioperative outcomes were gathered and analyzed. A multivariable analysis was conducted to identify factors associated with a favorable trifecta outcome, arbitrarily defined as a combination of the following postoperative events: International Prostate Symptom Score <8, maximum flow rate >15 ml/s, and no perioperative complications. Results and limitations: Overall, 1330 consecutive cases were analyzed, including 487 robotic (36.6{\%}) and 843 laparoscopic (63.4{\%}) SP cases. Median overall prostate volume was 100 ml (range: 89-128). Median estimated blood loss was 200 ml (range: 150-300). An intraoperative transfusion was required in 3.5{\%} of cases, an intraoperative complication was recorded in 2.2{\%} of cases, and the conversion rate was 3{\%}. Median length of stay was 4 d (range: 3-5). On pathology, prostate cancer was found in 4{\%} of cases. Overall postoperative complication rate was 10.6{\%}, mostly of low grade. At a median follow-up of 12 mo, a significant improvement was observed for subjective and objective indicators of BOO. Trifecta outcome was not significantly influenced by the type of procedure (robotic vs laparoscopic; p = 0.136; odds ratio [OR]: 1.6; 95{\%} confidence interval [CI], 0.8-2.9), whereas operative time (p = 0.01; OR: 0.9; 95{\%} CI, 0.9-1.0) and estimated blood loss ( p = 0.03; OR: 0.9; 95{\%} CI, 0.9-1.0) were the only two significant factors. Retrospective study design, lack of a control arm, and limited follow-up represent major limitations of the present analysis. Conclusions: This study provides the largest outcome analysis reported for MISP for BOO/BPE. These findings confirm that SP can be safely and effectively performed in a minimally invasive fashion in a variety of healthcare settings in which specific surgical expertise and technology is available. MISP can be considered a viable surgical treatment in cases of large prostatic adenomas. The use of robotic technology for this indication can be considered in centers that have a robotic program in place for other urologic indications. Patient summary: Analysis of a large data set from multiple institutions shows that surgical removal of symptomatic large prostatic adenomas can be carried out with good outcomes by using robot-assisted laparoscopy.",
author = "Riccardo Autorino and Homayoun Zargar and Mariano, {Mirandolino B.} and Rafael Sanchez-Salas and Sotelo, {Ren{\'e} J.} and Chlosta, {Piotr L.} and Octavio Castillo and Matei, {Deliu V.} and Antonio Celia and Gokhan Koc and Anup Vora and Monish Aron and Parsons, {J. Kellogg} and Giovannalberto Pini and Jensen, {James C.} and Douglas Sutherland and Xavier Cathelineau and Bragayrac, {Luciano A.Nunez} and Varkarakis, {Ioannis M.} and Daniele Amparore and Matteo Ferro and Gaetano Gallo and Alessandro Volpe and Hakan Vuruskan and Gaurav Bandi and Jonathan Hwang and Josh Nething and Nic Muruve and Sameer Chopra and Patel, {Nishant D.} and Ithaar Derweesh and Weeks, {David Champ} and Ryan Spier and Keith Kowalczyk and John Lynch and Andrew Harbin and Mohan Verghese and Srinivas Samavedi and Molina, {Wilson R.} and Emanuel Dias and Youness Ahallal and Humberto Laydner and Edward Cherullo and {De Cobelli}, Ottavio and Thiel, {David D.} and Mikael Lagerkvist and Haber, {Georges Pascal} and Jihad Kaouk and Kim, {Fernando J.} and Estevao Lima and Vipul Patel and Wesley White and Alexander Mottrie and Francesco Porpiglia",
year = "2015",
month = "1",
day = "1",
doi = "10.1016/j.eururo.2014.11.044",
language = "English (US)",
volume = "68",
pages = "86--94",
journal = "European Urology",
issn = "0302-2838",
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TY - JOUR

T1 - Perioperative outcomes of robotic and laparoscopic simple prostatectomy

T2 - A european-American multi-institutional analysis

AU - Autorino, Riccardo

AU - Zargar, Homayoun

AU - Mariano, Mirandolino B.

AU - Sanchez-Salas, Rafael

AU - Sotelo, René J.

AU - Chlosta, Piotr L.

AU - Castillo, Octavio

AU - Matei, Deliu V.

AU - Celia, Antonio

AU - Koc, Gokhan

AU - Vora, Anup

AU - Aron, Monish

AU - Parsons, J. Kellogg

AU - Pini, Giovannalberto

AU - Jensen, James C.

AU - Sutherland, Douglas

AU - Cathelineau, Xavier

AU - Bragayrac, Luciano A.Nunez

AU - Varkarakis, Ioannis M.

AU - Amparore, Daniele

AU - Ferro, Matteo

AU - Gallo, Gaetano

AU - Volpe, Alessandro

AU - Vuruskan, Hakan

AU - Bandi, Gaurav

AU - Hwang, Jonathan

AU - Nething, Josh

AU - Muruve, Nic

AU - Chopra, Sameer

AU - Patel, Nishant D.

AU - Derweesh, Ithaar

AU - Weeks, David Champ

AU - Spier, Ryan

AU - Kowalczyk, Keith

AU - Lynch, John

AU - Harbin, Andrew

AU - Verghese, Mohan

AU - Samavedi, Srinivas

AU - Molina, Wilson R.

AU - Dias, Emanuel

AU - Ahallal, Youness

AU - Laydner, Humberto

AU - Cherullo, Edward

AU - De Cobelli, Ottavio

AU - Thiel, David D.

AU - Lagerkvist, Mikael

AU - Haber, Georges Pascal

AU - Kaouk, Jihad

AU - Kim, Fernando J.

AU - Lima, Estevao

AU - Patel, Vipul

AU - White, Wesley

AU - Mottrie, Alexander

AU - Porpiglia, Francesco

PY - 2015/1/1

Y1 - 2015/1/1

N2 - Background: Laparoscopic and robotic simple prostatectomy (SP) have been introduced with the aim of reducing the morbidity of the standard open technique. Objective: To report a large multi-institutional series of minimally invasive SP (MISP). Design, setting, and participants: Consecutive cases of MISP done for the treatment of bladder outlet obstruction (BOO) due to benign prostatic enlargement (BPE) between 2000 and 2014 at 23 participating institutions in the Americas and Europe were included in this retrospective analysis. Intervention: Laparoscopic or robotic SP. Outcome measurements and statistical analysis: Demographic data and main perioperative outcomes were gathered and analyzed. A multivariable analysis was conducted to identify factors associated with a favorable trifecta outcome, arbitrarily defined as a combination of the following postoperative events: International Prostate Symptom Score <8, maximum flow rate >15 ml/s, and no perioperative complications. Results and limitations: Overall, 1330 consecutive cases were analyzed, including 487 robotic (36.6%) and 843 laparoscopic (63.4%) SP cases. Median overall prostate volume was 100 ml (range: 89-128). Median estimated blood loss was 200 ml (range: 150-300). An intraoperative transfusion was required in 3.5% of cases, an intraoperative complication was recorded in 2.2% of cases, and the conversion rate was 3%. Median length of stay was 4 d (range: 3-5). On pathology, prostate cancer was found in 4% of cases. Overall postoperative complication rate was 10.6%, mostly of low grade. At a median follow-up of 12 mo, a significant improvement was observed for subjective and objective indicators of BOO. Trifecta outcome was not significantly influenced by the type of procedure (robotic vs laparoscopic; p = 0.136; odds ratio [OR]: 1.6; 95% confidence interval [CI], 0.8-2.9), whereas operative time (p = 0.01; OR: 0.9; 95% CI, 0.9-1.0) and estimated blood loss ( p = 0.03; OR: 0.9; 95% CI, 0.9-1.0) were the only two significant factors. Retrospective study design, lack of a control arm, and limited follow-up represent major limitations of the present analysis. Conclusions: This study provides the largest outcome analysis reported for MISP for BOO/BPE. These findings confirm that SP can be safely and effectively performed in a minimally invasive fashion in a variety of healthcare settings in which specific surgical expertise and technology is available. MISP can be considered a viable surgical treatment in cases of large prostatic adenomas. The use of robotic technology for this indication can be considered in centers that have a robotic program in place for other urologic indications. Patient summary: Analysis of a large data set from multiple institutions shows that surgical removal of symptomatic large prostatic adenomas can be carried out with good outcomes by using robot-assisted laparoscopy.

AB - Background: Laparoscopic and robotic simple prostatectomy (SP) have been introduced with the aim of reducing the morbidity of the standard open technique. Objective: To report a large multi-institutional series of minimally invasive SP (MISP). Design, setting, and participants: Consecutive cases of MISP done for the treatment of bladder outlet obstruction (BOO) due to benign prostatic enlargement (BPE) between 2000 and 2014 at 23 participating institutions in the Americas and Europe were included in this retrospective analysis. Intervention: Laparoscopic or robotic SP. Outcome measurements and statistical analysis: Demographic data and main perioperative outcomes were gathered and analyzed. A multivariable analysis was conducted to identify factors associated with a favorable trifecta outcome, arbitrarily defined as a combination of the following postoperative events: International Prostate Symptom Score <8, maximum flow rate >15 ml/s, and no perioperative complications. Results and limitations: Overall, 1330 consecutive cases were analyzed, including 487 robotic (36.6%) and 843 laparoscopic (63.4%) SP cases. Median overall prostate volume was 100 ml (range: 89-128). Median estimated blood loss was 200 ml (range: 150-300). An intraoperative transfusion was required in 3.5% of cases, an intraoperative complication was recorded in 2.2% of cases, and the conversion rate was 3%. Median length of stay was 4 d (range: 3-5). On pathology, prostate cancer was found in 4% of cases. Overall postoperative complication rate was 10.6%, mostly of low grade. At a median follow-up of 12 mo, a significant improvement was observed for subjective and objective indicators of BOO. Trifecta outcome was not significantly influenced by the type of procedure (robotic vs laparoscopic; p = 0.136; odds ratio [OR]: 1.6; 95% confidence interval [CI], 0.8-2.9), whereas operative time (p = 0.01; OR: 0.9; 95% CI, 0.9-1.0) and estimated blood loss ( p = 0.03; OR: 0.9; 95% CI, 0.9-1.0) were the only two significant factors. Retrospective study design, lack of a control arm, and limited follow-up represent major limitations of the present analysis. Conclusions: This study provides the largest outcome analysis reported for MISP for BOO/BPE. These findings confirm that SP can be safely and effectively performed in a minimally invasive fashion in a variety of healthcare settings in which specific surgical expertise and technology is available. MISP can be considered a viable surgical treatment in cases of large prostatic adenomas. The use of robotic technology for this indication can be considered in centers that have a robotic program in place for other urologic indications. Patient summary: Analysis of a large data set from multiple institutions shows that surgical removal of symptomatic large prostatic adenomas can be carried out with good outcomes by using robot-assisted laparoscopy.

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JF - European Urology

SN - 0302-2838

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