Category: Laparoscopic/ Robotic: Prostate

MP15-17 - Perioperative And Oncologic Outcomes Of Anterior Versus Posterior Approach Robotics-Assited Laparoscopic Radical Prostatectomy (RALP)

Sat, Sep 22
10:00 AM - 12:00 PM

Introduction & Objective :

The approval of the Food and Drug Administration (FDA) for the use of Da Vinci Surgical System has revolutionized the treatment for prostate cancer. There have been two surgical approaches used in Robotics-assisted Laparoscopic Radical Prostatectomy (RALP), that is, the anterior and posterior approach to dissection of the seminal vesicle, an important step in the performance of RALP. 
Primarily, we aim to compare the perioperative and oncologic outcomes of each approach while minimizing the bias of learning curve by collating data after the performing cumulative summation of the console time of consecutive patients who underwent anterior or posterior RALP.  Secondary objective include the establishment of the minimum number of cases before a surgeon can enter the competent phase of the learning curve.

Methods : Chart review was performed on 111 patients who underwent RALP from 2014-2016 performed by 3 experienced robotic surgeons with interchangeability of role as console operator. Two arms were developed based on the approach of seminal vesicle dissection, that is, anterior and posterior approach. Cumulative summation was performed by plotting the cumulative sequential differences between each console time (CT) data point to divided the chart into two distinct phases: (a) negative slope learning phase and (b) positive slope competent phase. Only patients under the competent phases of each approach were included for analysis of the perioperative and oncologic outcomes.

Results : There were no significant differences in age, body mass index, prostate volume, preoperative prostate specific antigen (PSA), gleason score and oncologic risk. Pathology was almost similar with majority of cases under the anterior approach arm having gleason 7 (3+4) and posterior approach arm having gleason 6 (3+3). With a p-value of <0.05, console time was significantly shorter in the posterior approach at 121±25.95 when compared to anterior approach at 148±30.25 minutes. The other perioperative outcome such as estimated blood loss (EBL) and postoperative outcomes such as gleason score, pathologic tumor stage and positive surgical margin rate, and post-operative hospital stay were not significantly different between the groups.

Conclusions : In our experience, posterior approach RALP has provided a shorter console time, while the overall oncologic and perioperative outcomes for both approaches used in RALP were similar. The learning curve for the anterior approach is less steep than that of the posterior approach with only 14 versus 26 consecutive cases, respectively, to be able to competently perform the steps in RALP.

Jonathan S. Mendoza

St. Luke's Institute of Urology
Quezon, National Capital Region, Philippines

Jonathan S. Mendoza, MD is a 3rd year Urology Resident from St. Luke's Medical Center, Institute of Urology, Philippines.

Josefino C. Castillo

Quezon, National Capital Region, Philippines

Dennis Serrano

Quezon, National Capital Region, Philippines

Jason L. Letran

Quezon City, National Capital Region, Philippines