Is robotic improve laparoscopic radical prostatectomy in complex surgical cases?

The radical prostatectomy is the main treatment prostate cancer in young men. However in difficult cases, another therapeutic option is often suggested. Objective. - Evaluation of the quality of the anastomosis in complex surgical cases by comparing laparoscopic radical prostatectomy (LRP) to robotic assisted radical prostatectomy (RLRP). Material. - From March 2004 to August 2009, 397 patients underwent radical prostatectomy: 176 LRP and 221 RLRP consecutively by the same surgeon. Antecedents that might have complicated dissection were analyzed: prostatic volume over 80 cc, previous inguinal hernia repair with mesh, previous pelvic surgery, body mass index over 30 and previous trans-uretral resection of prostate. Results. - In a preoperative mode, there was no significant difference between the two groups. A multivariable analysis of the quality of the anastomosis turned to the advantage of the robot (OR = 2.56 [95 %Cl: 1.28-5.25]), specifically for difficult cases (Odd Ratio = 7.736 [95 %Cl: 2.689-22.254]). Conclusion. - The use of the robot improved the quality of the anastomosis for patients that might have raised technical issues. (C) 2010 Elsevier Masson SAS. All rights reserved.