Robot-assisted radical resection in prostate cancer comparative assessment with conventional laparoscopic prostatectomy: a retrospective comparative cohort study with single-center experience

Background: Radical prostatectomy is the standard of care in patients with prostate cancer. Robot-assisted prostatectomy have been used as alternatives to open surgery as they result in less bleeding and allow patients to return to normal activities sooner. This study sought to evaluate the medical factors and health economics of robot-assisted and laparoscopic-assisted prostate cancer surgery to provide a valuable reference for clinicians, patients, and their families when selecting a surgical method for prostate cancer. Methods: Patients treated with Da Vinci robot- assisted surgery (DVRS) or laparoscopic-assisted surgery (LS) between January 1, 2019, and June 1, 2021, were included in this retrospective analysis. The general baseline data included age, height, weight, body mass index (BMI), preoperative total prostate specific antigen (TPSA), Gleason score, tumor stage, operation time, intraoperative blood loss volume, hospital stay, drainage volume within 24 hours postoperatively, extubation time, postoperative hospital stay, and detailed hospitalization expenditure. The medical and health economics factors were compared between the two prostatectomy techniques. Results: The preoperative characteristics of the patients in the DVRS group and LS group were comparable, and the differences were not statistically significant (all P>0.05). Compared to the LS group, the operation time was significantly longer in the DVRS group, whereas the volume of intraoperative blood loss, hospital stay, extubation time, and postoperative hospital stay were all markedly lower (all P<0.05). Also, the treatment, nursing, and total operation costs were considerably lower in the DVRS group compared to the LS group, while the medical material cost, total hospitalization cost, and personal expenses were all notably higher (all P<0.05). Conclusions: Da Vinci robot-assisted prostatectomy is safe; however, the health economics should not be neglected that the robot-assisted operation cannot completely replace the conventional laparoscopic operation in the short term. The consideration of both clinical efficacy and health economics is necessary to provide suggestions for the choice of modus operandi.