Should we shift to retzius-preserving robotic assisted laparoscopic radical prostatectomy?
Chia-yen Lin, Yen-chuan Ou, Cheng-kuang Yang
Purpose: Open radical cystectomy with urinary diversion is gold standard management for invasive bladder cancer. Minimal invasive radical cystectomy had been developed for more than ten years. We describe our 3 years experience of conventional laparoscopic radical cystectomy(LRC) with extracorporeal urinary diversion via 3cm wound incisions. We performed robotic assisted laparoscopic radical cystectomy (RaLRC) with intracoporeal urinary diversion in the past 12 months.In this study, We aim to
... mpare the perioperative outcomes of these two different minimalinvasive approaches to open radical cystectomy Materials and Methods: From January 2011 to Dec 2014, 10 open cystectomy, 28 consecutive patients underwent conventional laparoscopic radical cystectomy with extracoporeal urinary diversion, 17 patients underwent robotic assisted laparoscopic radical cystectomy (RaLRC) with 8 cases of intracoporeal and 9 cases of extracoporeal urinary diversion by a single surgical team. Perioperative outcome include operative time ( lymph node dissection with cystectomy time, urinary diversion time ), blood loss, time to return to diet, one month complication rate and length of hospital stay. Oncological outcome included dissected lymph node numbers, LN positive rate, postive surgical margin and 1 year disease free survival rate. Results: There is no significant differences in estimated blood loss,blood transfusion rate and ileus rate between these two minmal invasive groups, but greater in open cystectomy group. Besides there were no significant differences in time toreturn to diet, pain score, pathological stage and positive surgical margin rate between three groups. Similar operative time for lymph node dissection with radical cystectomy in two minimal invasive groups. (Mean time: 164.6 minutes for LRC and 148.2 for RaLRC) Shorter operative time for extracorporeal urinary diversion (Extracorporeal ileal conduit : 72.3 minutes, Extracorporeal neobladder : 108.7 minutes, intracorporeal ileal conduit : 175.8 minutes and intracorporeal neobladder : 249.3 minutes) Average dissected LN numbers are 24.6 in ORC, 34.5 in LRC and 42.8 in RaLRC. There was no perioperative bowel injury in these three groups. No ureteral complication in extracorporeal urinary diversion group, but 3 ureteral complication withl urine leakage in intracorporeal group.The 1-year disease free survival rate was 92.7% in the LRC group and the 1-year overall survival rates were both 100%. Conclusion: Our experience shows that minimal invasive radical cystectomy with extracorporeal urinary diversion via small incisions is a safe and feasible surgical technique with acceptable perioperative results. RaLRC seemed more precisely in lymph node dissection and cystectomies,but long operative time and more urinary complications in intracorporeal urinary diversion. We try to step over the learning curve of intracorporeal urinary diversion, besides more convincing results with a longer follow-up period and large number of cases are necessary to validate our findings. Purpose: Some studies reported an comparable oncological outcome and better early continence rate of Retzius-preserving robotic assisted laparoscopic radical prostatectomy (RALP). We want to compare the early perioperative and continence outcome. And we are also eager to know if the learning curve of Retzius-preserving surgery would compromise the outcome or not? Materials and Methods: We selected patient with organ-confined prostate cancer ( cT2c), PSA 40, Gleason score of biopsy 8, prostate volume 50 ml and BMI < 35. We plan to collect consecutive 50 cases from Febuary, 2015. We design a case control matching study with 25 cases of each Retzius-preserving RALP and conventional RALP group. Postoperative parameter and early continence result was compared. This is our early result of original study design. Results: From Febuary 1, 2015 to March 17, 2015, a total consecutive 21 cases of RALP were evaluated. Eight of them underwent Retzius-preserving RALP. There is no statistical difference of preoperative characteristics. There were no significant differences in mean length of hospital stay, intraand postoperative complication rates, pathological stage of disease, Gleason scores, tumour volumes and positive surgical margins between the conventional RALP and Retzius-sparing RALP groups. However, console time, Vesicourethral anastomosis time and estimated blood loss Console time were longer for Retzius-sparing RALP. There is no significant difference of early continence at 4 weeks between. Conclusion: Based on the early result of this study, Retzius-preserving RALP is a feasible and safe treatment choice for localized prostate cancer. Both console time and estimated blood loss are favoring to conventional RALP. Further study and accumulation of experience are needed for final conclusion.