Background: The best technique of radical prostatectomy - open versus robot-assisted approach - is controversially discussed. In this study, we compared the complication rates of open and robot-assisted radical prostatectomy during the introduction and subsequent routine use of a da Vinci® robotic device while open surgery remained the standard approach. Patients and Methods: Between January 1st, 2006, and June 4th, 2012, 2,754 men underwent radical prostatectomy at our department. Among them, 317 received robot-assisted and 2,438 open surgery. According to the requirements for prostate cancer centers certified by the Deutsche Krebsgesellschaft (German Cancer Society), a prospective database recording perioperative complications was built up. The complication rates of open and robot-assisted radical prostatectomy were compared with the χ2 or Fisher exact test. The distributions of quantitative variables were compared with U tests. Results: Whereas the demographic factors favored patients selected for robot-assisted radical prostatectomy, there were no differences between open and robot-assisted surgery concerning length of stay, autologous blood transfusion rates and the incidence of perioperative complications. Conclusions: Open and robot-assisted radical prostatectomy had comparable complication rates. With better patient- and tumor-related parameters as well as decreasing transfusion rates in the robot-assisted subgroup, this observation might reflect the learning curves of the involved robotic surgeons.

1.
Heidenreich A, Bastian PJ, Bellmunt J, Bolla M, Joniau S, Mason MD, Matveev V, Mottet N, van der Kwast TH, Wiegel T, Zattoni F: EAU guidelines on prostate cancer. Update 2012. Available at website: http://www.uroweb.org/gls/pdf/08%20Prostate%20Cancer_LR%20March%2013th%202012.pdf (accessed: October 4, 2012).
2.
Moreno Sierra J, Fernández Pérez C, Ortiz Oshiro E, Silmi Moyano A, Villavicencio Mavrich H, Pereira Arias JG, Allona Almagro A, Unda Urzaiz M, Padilla Nieva J, Madina Albisua I, Estebanez Zarranz J, Medina López R, Baena Gonzalez V, Franco Miranda E, Morote Robles J, Gomez Ruiz JJ: Key areas in the learning curve for robotic urological surgery: a Spanish multicentre survey. Urol Int 2011;87:64-69.
3.
Shigemura K, Yamanaka N, Yamashita M: Veil nerve-sparing technique and postoperative urinary continence in open antegrade radical prostatectomy. Urol Int 2012;89:283-289.
4.
Novara G, Ficarra V, Rosen RC, Artibani W, Costello A, Eastham JA, Graefen M, Guazzoni G, Shariat SF, Stolzenburg JU, Van Poppel H, Zattoni F, Montorsi F, Mottrie A, Wilson TG: Systematic review and meta-analysis of perioperative outcomes and complications after robot-assisted radical prostatectomy. Eur Urol 2012;62:431-452.
5.
Khoder WY, Trottmann M, Buchner A, Stuber A, Hoffmann S, Stief CG, Becker AJ: Risk factors for pelvic lymphoceles post-radical prostatectomy. Int J Urol 2011;18:638-643.
6.
Naselli A, Andreatta R, Introini C, Fontana V, Puppo P: Predictors of symptomatic lymphocele after lymph node excision and radical prostatectomy. Urology 2010;75:630-635.
7.
Orvieto MA, Coelho RF, Chauhan S, Palmer KJ, Rocco B, Patel VR: Incidence of lymphoceles after robot-assisted pelvic lymph node dissection. BJU Int 2011;108:1185-1190.
8.
Coelho RF, Palmer KJ, Rocco B, Moniz RR, Chauhan S, Orvieto MA, Coughlin G, Patel VR: Early complication rates in a single-surgeon series of 2500 robotic-assisted radical prostatectomies: report applying a standardized grading system. Eur Urol 2010;57:945-952.
9.
Wirth MP, Froehner M: Radical prostatectomy-only centers: the future in genitourinary surgery? Eur Urol 2010;57:953-954.
10.
Deutsche Gesellschaft für Urologie e.V: Interdisziplinäre Leitlinie der Qualität S3 zur Früherkennung, Diagnose und Therapie der verschiedenen Stadien des Prostatakarzinoms. Version 2.0 - 1. Aktualisierung 2011. Available at website: http://www.awmf.org/uploads/tx_szleitlinien/043022OLk_S3_Prostatakarzinom_2011.pdf (accessed October 4, 2012).
11.
Artibani W, Fracalanza S, Cavalleri S, Iafrate M, Aragona M, Novara G, Gardiman M, Ficarra V: Learning curve and preliminary experience with da Vinci-assisted laparoscopic radical prostatectomy. Urol Int 2008;80:237-244.
12.
Dindo D, Demartines N, Clavien PA: Classification of surgical complications: a new proposal with evaluation in a cohort of 6,336 patients and results of a survey. Ann Surg 2004;240:205-213.
13.
Mitropoulos D, Artibani W, Graefen M, Remzi M, Rouprêt M, Truss M, European Association of Urology Guidelines Panel: Reporting and grading of complications after urologic surgical procedures: an ad hoc EAU guidelines panel assessment and recommendations. Eur Urol 2012;61:341-349.
Copyright / Drug Dosage / Disclaimer
Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher.
Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug.
Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.
You do not currently have access to this content.