Prostatectomia radical minimamente invasiva: transición de laparoscopia pura a laparoscopia asistida por robot / Minimally invasive radical prostatectomy: transition from pure laparoscopic to robotic-assisted radical prostatectomy

RESUMEN

OBJETIVO: El abordaje laparoscópico asistido por robot en la prostatectomía radical es cada vez más utilizado y se ha convertido en una modalidad de tratamiento oncológico efectivo bien documentado. En este estudio, presentamos la experiencia inicial de un solo cirujano en una sola institución con prostatectomía laparoscópica asistida por robot (PRAR) estableciendo una comparación con su experiencia previa en la prostatectomía laparoscópica pura (PRL).MÉTODOS: Se trata de una revisión retrospectiva de los resultados quirúrgicos de un solo cirujano realizando la PRL y la transición a la PRAR. Las características básicas y los resultados obtenidos de doscientos setenta y cinco pacientes sometidos a PRR por un único y entrenado, urólogo oncológico, se analizaron y se compararon con 45 pacientes sometidos a prostatectomía radical laparoscópica por el mismo cirujano. Se evaluaron las características de los pacientes, de los tumores y de la técnica operatoria, así como los resultados funcionales. Se utilizaron cuestionarios validados, incluyendo el International Prostate Symptom Score (IPSS) y el Índice Internacional de Función Eréctil (IIEF), en la evaluación de los parámetros urinarios y sexuales(AU)

ABSTRACT

OBJECTIVES: The robotic-assisted laparoscopic approach to radical prostatectomy is increasingly utilized and has become well documented as an effective oncologic treatment modality. In this study, we report the initial experience of a single surgeon at a single institution with robotic-assisted laparoscopic prostatectomy (RALP) drawing a comparison to his prior experience with pure laparoscopic prostatectomy (LRP).METHODS: This is a retrospective review of surgical results from a single surgeon performing LRP and transitioning to RALP. Baseline characteristics and outcomes of two hundred seventy five patients undergoing RALP by a single, fellowship-trained, urologic oncologist were analyzed and compared to 45 patients undergoing LRP by the same surgeon. Patient, tumor, and operative characteristics as well as functional outcomes were evaluated. Validated questionnaires, including the International Prostate Symptom Score (IPSS) and International Index of Erectile Function (IIEF), were utilized in the assessment of urinary and sexual parameters. RESULTS: Preoperative patient and tumor characteristics (age, PSA, Gleason score) were similar in both the LRP and RALP groups. Mean operative time (195 vs. 299 minutes), estimated blood loss (223 vs. 299 mL), need for blood transfusion (1.5% vs. 4.4%) and mean length of stay (1.95 vs. 2.63 days) were significantly reduced among patients undergoing RALP as compared to those undergoing LRP. In terms of functional outcomes, continence at 12 months was better among patients undergoing RALP as compared to LRP (94% vs. 82%). In preoperatively potent men undergoing bilateral nerve sparing procedures, RALP conferred 82% potency at 24 months as opposed to only 62% following LRP.CONCLUSIONS: The combination of adjustment in surgical technique from LRP to RALP along with a concurrent institutional commitment to a successful robotic surgery program, has yielded superior operative, oncologic, and functional results(AU)