A role for laparoscopy in the age of robotics: a retrospective cohort study of perioperative outcomes between 2D laparoscopic radical prostatectomy vs 3DHD laparoscopic radical prostatectomy.

Autor: Engel-Rodriguez A; St. Luke's Episcopal Hospital, Ponce, PR, 00733, USA.; VA Caribbean Healthcare Systems, San Juan, 00921, USA., Ruiz-Irizarry I; St. Luke's Episcopal Hospital, Ponce, PR, 00733, USA.; Nova Southeastern University-Puerto Rico Regional Campus, San Juan, PR, 00926, USA., Engel-Rodriguez N; St. Luke's Episcopal Hospital, Ponce, PR, 00733, USA.; San Juan Bautista School of Medicine, Caguas, PR, 00727, USA., Ortiz-Sánchez C; Department of Basic Sciences, Ponce Research Institute, Ponce Health Sciences University, Ponce, PR, USA., Encarnación-Medina J; Department of Basic Sciences, Ponce Research Institute, Ponce Health Sciences University, Ponce, PR, USA., Ruiz-Deya G; St. Luke's Episcopal Hospital, Ponce, PR, 00733, USA. gruizdeya@gmail.com.; Department of Surgery, Ponce Health Sciences University, Ponce, PR, 00716-2347, USA. gruizdeya@gmail.com.
Jazyk: angličtina
Zdroj: World journal of urology [World J Urol] 2023 Feb; Vol. 41 (2), pp. 443-448. Date of Electronic Publication: 2023 Jan 23.
DOI: 10.1007/s00345-022-04276-w
Abstrakt: Purpose: Our study compares perioperative outcomes between two-dimensional (2D) laparoscopic radical prostatectomy (LRP) and the 4th generation three-dimensional/high definition (3DHD) LRP.
Methods: Retrospectively acquired data from patients that underwent 2D LRP (n = 75) and 3DHD LRP (n = 75) from March 2013 to October 2015 were evaluated. Procedures were performed by a single surgeon. The extra-peritoneal approach with 5 trocars was utilized. Perioperative outcomes, potency, and continence were compared between groups.
Results: Patient characteristics were similar between the two groups in terms of age (p = 0.44), prostate-specific antigen (PSA) levels (p = 0.34), and Gleason scores (p = 0.14). Body mass index (BMI) was significantly higher in the 3DHD group (p = 0.0036). Postoperatively, no significant differences were observed in Hgb loss (p = 0.50), positive surgical margins (p = 1.00), and post-op Gleason scores (p = 0.30). Significant differences were observed for length of hospital stay (p < 0.001) and Jackson-Pratt (JP) drainage (p < 0.001). Regarding potency, 73.7% and 51.6% of the patients in the 3DHD and 2D groups regained potency at 6 months, respectively (p = 0.0025). Almost 43% of the patients in the 3DHD group regained continence at 1 month while for the 2D groups it was only 17.3% (p = 0.0008).
Conclusion: 3DHD and 2D LRP have resulted in good outcomes in the perioperative periods. Our results show decreased JP drainage, shorter length of hospital stay, earlier return of urinary control, and earlier return of sexual function in the 3DHD LRP group. In lower volume centers where robotics equipment is not feasible due to economic barriers 3DHD can be safely performed as a minimally invasive alternative.
(© 2023. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)
Databáze: MEDLINE
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