Perioperative and oncologic outcomes of anterior versus posterior approach robot-assisted laparoscopic radical prostatectomy.
- Author:
Jonathan S. Mendoza
;
Patrick Vincent P. Tanseco
;
Josefino C. Castillo
;
Dennis P. Serrano
;
Jason L. Letran
- Publication Type:Journal Article
- Keywords:
Robot-assisted laparoscopic radical prostatectomy (RALP)
- From:
Philippine Journal of Urology
2018;28(1):67-72
- CountryPhilippines
- Language:English
-
Abstract:
INTRODUCTION:Robot-assisted laparoscopic radical prostatectomy is now considered the gold standardtreatment of prostate adenocarcinoma in the modern world. There are two approaches to the precisedissection of seminal vesicles (anterior and posterior) during a laparoscopic radical prostatectomy,each of which with unique advantages and disadvantages. Primarily, the authors compared theintraoperative and oncological outcomes of these two approaches. Secondary objective included theestablishment of the minimum number of cases before a surgeon can enter the competent phase of thelearning curve.
MATERIALS AND METHODS:Chart review was performed on 111 patients who underwent RALP from2014-2016 performed by 3 experienced robotic surgeons with interchangeability of role as consoleoperator. Two arms were developed based on the approach of seminal vesicle dissection, that is,anterior and posterior approach. Cumulative summation of the console time was performed to obtaina chart with a) negative slope-learning phase and b) positive slope-competent phase. Patients underthe competent phases were included for analysis.
RESULTS:There were no significant differences in age, body mass index, prostate volume, preoperativeprostate specific antigen (PSA), gleason score and oncologic risk. Pathology was almost similar inmajority of cases under the anterior approach arm being gleason 7 (3+4) and posterior approach armbeing gleason 6 (3+3). With a p-value of <0.05, console time was significantly shorter in the posteriorapproach at 121±25.95 when compared to anterior approach at 148±30.25 minutes. The otherperioperative and postoperative outcomes were not significantly different between the groups.
CONCLUSION:Posterior approach has provided a shorter console time, while the overall oncologic andperioperative outcomes for both approaches were similar. The learning curve for the anterior approachis less steep than that of the posterior approach with only 14 versus 26 consecutive cases, respectively,to be able to competently perform RALP.
- Full text:Perioperative and oncologic outcomes of anterior.pdf
