Introduction of robot-assisted radical prostatectomy: Outcomes of a cohort comprising the initial 100 patients compared with those of patients who underwent laparoscopic radical prostatectomy

In Japan, the modalities of radical prostatectomy are changing drastically due to recent innovation of the Japanese social health insurance system regarding surgery for prostate cancer (PCa). We compared outcomes between a cohort comprising the initial 100 patients who underwent robot-assisted radical prostatectomy (RALP) and patients who had undergone laparoscopic radical prostatectomy (LRP). Between September 2012, when we initiated RALP, and September 2013, we performed this operation on 100 patients. All the surgeries were undertaken by a single surgical team conducted by the Director of the Department of Urology. Peri-surgical outcomes, pathological findings and continence status were compared with those of 141 patients who had undergone LRP. Preoperative parameters (age, PSA, Gleason score) were similar in both the RALP and LRP groups. Operative time (169 vs. 209 minutes) and estimated blood loss (minimal vs. 77 ml) were reduced in the RALP group vs. the LRP group. Peri-operative complications in the RALP group appeared to be minimal, with no cases of intra-operative open conversion. On the other hand, severe complications, including 3 rectal injuries, were observed in 6 cases in the LRP group. Although not statistically significant, there was a lower positive margin rate in organ-confined (pT2) disease (7.1%, RALP vs. 16%, LRP). Continence at 1 month was 76% following RALP as opposed to 41% after LRP. The transition to RALP from LRP has yielded superior operative, oncologic, and functional results.