New techniques, robotics benefit laparoscopic RP

February 1, 2005

Mumbai, India--Technical advances in laparoscopic radical prostatectomy continue to improve the safety and efficacy of the procedure, according to a number of reports from the World Congress on Endourology here.

Robot-assisted anatomical prostatectomy, also known as Vattikuti Institute Prostatectomy (VIP), is safe and effective for the treatment of clinically localized prostate cancer, according to a prospective comparative study between robot-assisted and conventional radical retropubic prostatectomy conducted by investigators at Vattikuti Urology Institute, Detroit.

Comparison of intraoperative parameters revealed that mean blood loss was significantly lower in the VIP group (131 mL) compared with the open prostatectomy group (869 mL, p<.001). The drop in hemoglobin was 4.2 grams in the open group compared with 1.2 grams in the VIP group. Consequently, greater numbers of intraoperative blood units were transfused in the open versus the VIP group (75% vs. 0% respectively, p<.001).

Magnification, clarity excel The VIP arm also performed favorably in terms of postoperative convalescence and patient recovery. The mean pain score on postoperative day 1 was 7 in the open prostatectomy group and 3 in the VIP group (p=.05). The median length of hospitalization was 1 day in the VIP group compared with 3 days in the open group. The duration of catheterization was 15.8 days for open prostatectomy and 8.2 days for the VIP group (p<.001). Additionally, the complication rates were 5% for VIP and 15% for open prostatectomy.

In terms of margin status, the VIP group had an overall margin positive rate of 9%. In T2 cancers, the margin rates were 23% for open prostatectomy and 5% for VIP.

"Good magnification and excellent clarity of the operative field afforded by the daVinci robot allow us to achieve these excellent margin rates despite staying close to the gland during the dissection," Dr. Kaul, admitting a limitation of the system is the high installation and running cost involved.

Given the current costs, robot-assisted prostatectomy is an economically viable option only in high-volume centers, he noted.