Robotic-assisted Laparoscopic Prostatectomy: Initial Experience of 267 Cases

Objective: To present our experience of 267 consecutive patients treated with robotic-assisted laparoscopic prostatectomy (RALP) and assess the perioperative and postoperative outcomes. Materials and Methods: We retrospectively analyzed the data of 267 men who underwent RALP in our clinic between March 2015 and April 2018. Preoperative clinical data including age, serum prostate-specific antigen (PSA), biopsy Gleason score, and number of positive cores were noted. Perioperative parameters such as operative time and intraoperative complications were recorded. Postoperative parameters including hematocrit change, length of hospital stay, and catheter removal date were noted. Pathological outcomes included pathological Gleason score; positive surgical margin (PSM) status; extracapsular, lymphovascular, perineural, and seminal vesicle invasion; and lymph node positivity. The Clavien-Dindo system was used to classify surgical complications. Results: The mean age of the patients was 64.2 +/- 6.4 years and the median PSA was 8.27 ng/dL. The mean operative time was 196.4 +/- 59.4 min and median hematocrit decrease was 3.9%. The overall PSM rate was 21.34% and this rate increased significantly with final pathological stage from 12.97% for pT2 to 35.48% for pT3 (p<0.05). Over a mean follow-up time of 19 months, biochemical recurrence occured in 29 patients (9.7%) and a total of 35 patients (22%) required additional treatment. A total of 29 patients (10.86%) had complications and 1 patient required surgical intervention in the first 48 hours after surgery. The median postoperative hospital stay was 3 days and median time to urethral catheter removal was 10 days. Conclusion: Our initial experience with RALP is promising. Oncological outcomes were satisfactory, with patients benefiting from the advantages of the minimally invasive surgical approach.