Robot-assisted simple prostatectomy (RASP): does it make sense?

OBJECTIVE To evaluate the outcome, feasibility and reproducibility of a robot-assisted (RA) approach for simple prostatectomy (SP) in cases of high-volume symptomatic benign prostatic hyperplasia (HVS-BPH). PATIENTS AND METHODS In all, 35 consecutive patients underwent RASP for HVS-BPH using a previously described technique. The mean prostate volume on preoperative transrectal ultrasonography was 106.6 mL. All but two patients (with bladder calculi) had an adenoma volume of >65 mL and 27 (77.1%) >80 mL. Nine patients (25.7%) had an indwelling catheter. The mean International Prostate Symptom Score (IPSS) was 28. RESULTS The median operative duration was 180 min and the mean hospital stay was 3.17 days. The mean catheter duration was 7.4 days and discontinuous or continuous catheter irrigation was required in two and seven patients, respectively (25.1%). In all, 10 patients (28.6%) had practically no blood loss. No patients had a transfusion. The mean postoperative peak urinary flow was 18.9 mL/s (P < 0.001), while the mean IPSS was 7 (P < 0.001). For costs, while superficially RASP appeared more expensive than open SP (OSP), when considering the higher costs of hospitalisation for OSP, RASP was cheaper. Also, bipolar-TURP costs in patients with large-volume prostates had rather similar costs to RASP. CONCLUSIONS RASP is a feasible and reproducible procedure with outcome advantages when compared with the open or with other minimally invasive techniques (laser or laparoscopy). As a result, a RA approach is worth considering in cases of high-volume prostate adenomas. Extending the indication of the RA approach, to the SP, requires firstly that the surgeon be proficient in RA surgery and secondly that as the incidence rate of HVS-BPH is low, the surgeon has had the opportunity to 'see the procedure'.