Clinical References
The following selected publications support the clinical efficacy of da Vinci® Urologic Surgery. For additional citations on robotic surgery, please visit PubMed (Medline).
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| Prostatectomy: By approach: By year: |
Clinical Studies: Robotic-Assisted versus Open Prostatectomy
"A prospective, non-randomized trial comparing robot-assisted laparoscopic and retropubic radical prostatectomy in one European institution." Ficarra, V., G. Novara, et al. (2009). BJU Int.
OBJECTIVE: To compare the functional results of two contemporary series of patients with clinically localized prostate cancer treated by robot-assisted laparoscopic prostatectomy (RALP) or retropubic radical prostatectomy (RRP).
PATIENTS AND METHODS: This was a non-randomized prospective comparative study of all patients undergoing RALP or RRP for clinically localized prostate cancer at our institution from February 2006 to April 2007.
RESULTS: We enrolled 105 patients in the RRP and 103 in the RALP group; the two groups were comparable for all clinical and pathological variables, except median age. For RRP and RALP the respective median operative duration was 135 and 185 min (P < 0.001), the intraoperative blood loss 500 and 300 mL (P < 0.001) and postoperative transfusion rates 14% and 1.9% (P < 0.01). There were complications in 9.7% and 10.4% of the patients (P = 0.854) after RRP and RALP, respectively; the positive surgical margin rates in pT2 cancers were 12.2% and 11.7% (P = 0.70). For urinary continence, 41% of patients having RRP and 68.9% of those having RALP were continent at catheter removal (P < 0.001). The 12-month continence rates were 88% after RRP and 97% after RALP (P = 0.01), with the mean time to continence being 75 and 25 days (P < 0.001), respectively. At the 12-month follow-up, 20 of 41 patients having bilateral nerve-sparing RRP (49%) and 52 of 64 having bilateral nerve-sparing RALP (81%) (P < 0.001) had recovery of erectile function.
CONCLUSIONS: RALP offers better results than RRP in terms of urinary continence and erectile function recovery, with similar positive surgical margin rates.
"Robotic vs open prostatectomy in a laparoscopically naive centre: a matched-pair analysis."
Rocco, B., D. V. Matei, et al. (2009). BJU Int.
OBJECTIVE: To compare the early oncological, perioperative and functional outcomes of robotic-assisted radical prostatectomy (RARP) vs open retropubic RP (RRP) in a laparoscopically naive centre, as robotic assistance aids the laparoscopically naive surgeon in minimally invasive prostate surgery, by offering magnification and superior dexterity.
PATIENTS AND METHODS: From 1 November 2006 to 31 December 2007, 120 patients had RARP; this group was followed prospectively and evaluated for early oncological, perioperative and functional outcomes (measured at 3, 6 and 12 months after surgery), and compared to a historical control group of consecutive patients who had RRP from 20 May 2004 to 28 February 2007. All patients were operated by the same laparoscopically naive surgeons. The comparison was by matched-pair analysis.
RESULTS: The baseline characteristics of the two groups were equivalent, although there was a higher percentage of patients with pT3/pT4 disease in the RRP group. As a proxy for oncological outcome, positive surgical margins were equivalent in the two groups (22% RARP vs 25% RRP, P = 0.77). The overall mean (range) surgical duration was significantly longer in RARP group, at 215 (165-450) min vs 160 (90-240) min in the RRP group (P < 0.001). However, RARP had a statistically significant advantage over RRP for estimated blood loss, of 200 vs 800 mL (P < 0.001), duration of catheterization (6 vs 7 days P < 0.001) and length of stay (3 vs 6 days, P < 0.001) The 3, 6 and 12-month continence rates were 70%, 93% and 97% vs 63%, 83% and 88% after RARP and RRP, respectively (P = 0.15, 0.011 and 0.014). The 3, 6 and 12 month overall potency recovery rate was 31%, 43% and 61% vs 18%, 31% and 41%, after RARP and RRP, respectively (P = 0.006, 0.045 and 0.003).
CONCLUSION: Our initial experience showed the feasibility of RARP in a laparoscopically naive centre. RRP seems to be a faster procedure, whereas RARP provided better results in terms of estimated blood loss, hospitalization and functional results. The early oncological outcome seemed to be equivalent in the two groups.
"Radical prostatectomy for prostatic adenocarcinoma: A matched comparison of open retropubic and robot-assisted techniques."
Krambeck, A. E., D. S. DiMarco, et al. (2009). BJU International 103(4): 448-453.
OBJECTIVE: To assess the perioperative complications and early oncological results in a comparative study matching open radical retropubic (RRP) and robot-assisted radical prostatectomy (RARP) groups.
PATIENTS AND METHODS: From August 2002 to December 2005 we identified 294 patients undergoing RARP for clinically localized prostate cancer. A comparison RRP group of 588 patients from the same period was matched 2:1 for surgical year, age, preoperative prostate-specific antigen level, clinical stage and biopsy Gleason grade. Perioperative complications were compared. Patients completed a standardized quality-of-life questionnaire. Pathological features were assessed and Kaplan-Meier estimates of biochemical progression-free survival (PFS) were compared.
RESULTS: There was no significant difference in overall perioperative complications between the RARP and RRP groups (8.0% vs 4.8%, P = 0.064). Wound herniation was more common after RARP (1.0% vs none, P = 0.038), and development of bladder neck contracture was more common after RRP (1.2% vs 4.6%; P < 0.018). The hospital stay was less after RARP (29.3% vs 19.4%, P = 0.004, for a stay of 1 day). At the 1-year follow-up there was no significant difference in continence (RARP 91.8%, RRP 93.7%, P = 0.344) or potency (RARP 70.0%, RRP 62.8%, P = 0.081) rates. The biochemical PFS was no different between treatments at 3 years (RARP 92.4%, RRP 92.2%; P = 0.69).
CONCLUSION: There was no significant difference in overall early complication, long-term continence or potency rates between the RARP and RRP techniques. Furthermore, early oncological outcomes were similar, with equivalent margin positivity and PFS between the groups. © 2008 The Authors.
"Open versus robotic radical prostatectomy: A prospective analysis based on a single surgeon's experience."
Ham, W. S., S. Y. Park, et al. (2008). Journal of Robotic Surgery 2(4): 235-241.
The background of this study is to compare prospectively the oncological and functional results of open radical prostatectomy (OP) and robotic prostatectomy (RP) from the experience of a single surgeon. Between June 2002 and June 2007, 422 patients underwent radical prostatectomy (OP 199, RP 223). We divided OP patients into 89 early cases (OP-I) and 110 late cases (OP-II) before and after introduction of a robotic system, and RP patients into 35 early cases (RP-I) and 188 late cases (RP-II). Functional outcomes were measured by use of validated questionnaires completed by the patients. There were no significant differences in preoperative characteristics among the four groups, except that RP-I patients had lower biopsy Gleason scores. In the RP groups the mean estimated blood loss was lower and mean durations of hospital stay and bladder catheterization were shorter compared to those of the OP groups. The frequency of intraoperative complications was significantly lower in the RP-II group. The positive surgical margin rates in the RP-II group were similar to or lower than those in the OP groups when stratified by pathologic stage T2 and T3. From one month after surgery, RP-II patients had higher continence rates than OP-II patients. For patients 60 years old, recovery of potency was better in the RP-II group. To conclude, RP by an experienced surgeon may have a similar or lower positive surgical margin rate than OP. Additionally, RP may lead to a shorter duration of bladder catheterization and hospital stay and better recovery of continence and potency than obtainable by OP. © 2008 Springer-Verlag London Ltd.
"Robot-assisted versus open radical prostatectomy: a comparison of one surgeon's outcomes."
Ahlering, T. E., D. Woo, et al. (2004). Urology 63(5): 819-822.
OBJECTIVES: To compare internally one surgeon's standard open radical prostatectomy (RP) and robot-assisted laparoscopic RP (RLP) results. RLP, like standard laparoscopic RP, ultimately needs to produce similar or improved results compared with standard RP techniques. Little information comparing RLP with standard RP exists.
METHODS: As an internal control, we selected the last 60 standard RPs performed by one surgeon (T.A.) before initiating RLPs. For the RLP group, we selected cases 46 to 105 (n = 60) after the learning curve had adequately matured. We compared the clinical characteristics, perioperative results, and early clinical outcomes.
RESULTS: The study and control groups had similar clinical characteristics (age, body size, preoperative prostate-specific antigen level, clinical stage, and Gleason score). No statistically significant differences were found between groups for prostate size, pT stage, Gleason score, or margin status (16.7% versus 20%; P = nonsignificant). The RLP group had a statistically significant advantage for estimated blood loss (103 versus 418 mL), postoperative hemoglobin change (1.6 versus 3.3 mg/dL), and hospital stay (1.02 versus 2.2 days). Complete continence (0 pads) at 3 months of follow-up and the rate of postoperative complications were similar for the RLP and RP groups (76% versus 75% and 6.7% versus 10%, respectively).
CONCLUSIONS: We present the results of RLP and RP performed by one surgeon. With only a 100-case experience, RLP had oncologic and urinary outcomes that were at least equal to those after RP. RLP offers the benefits of minimally invasive surgery and does not compromise clinical or pathologic outcomes.
"A prospective comparison of radical retropubic and robot-assisted prostatectomy: experience in one institution."
Tewari, A., A. Srivasatava, et al. (2003). BJU Int 92(3): 205-210.
The authors from the Vattikuti Institute in the USA report a prospective comparison of radical prostatectomy and robot-assisted prostatectomy. They found that the robot-assisted procedure was safer, and yielded favourable oncological and functional results. They also present work in association with the Department of Urology in Mansoura into robot-assisted radical cystoprostatectomy and urinary diversion, and point out the advantages and disadvantages associated with performing the most complex types of urinary diversion. There is also an interesting paper relating to the association between sexual factors and prostate cancer, from authors in institutions in Australia, New Zealand and Italy. They found that in a case-control study of men aged <70 years, ejaculatory frequency was negatively associated with the risk of prostate cancer. Technology has made many contributions to the management of urological patients. The classic example is that of urinary stone management. Authors from the USA evaluated cyroablation of renal carcinoma in patients with solitary kidneys. They are encouraged by their results and suggest that there is merit in this treatment, but indicate the need for a longer follow-up.
OBJECTIVE: To prospectively compare standard radical retropubic prostatectomy (RRP) and the robotically assisted Vattikuti Institute prostatectomy (VIP) in the management of localized prostate cancer.
PATIENTS AND METHODS: The study was a single-institution, prospective, unrandomized comparison of histopathological, and functional outcomes, at baseline and during and after surgery, in 100 patients undergoing RRP and 200 undergoing VIP.
RESULTS: While the variables before surgery, the operative duration (163 vs 160 min) and pathological stages were comparable, there were significant differences in the measured outcomes. The blood loss was 910 and 150 mL for RRP and VIP, respectively, and transfusion was greater after RRP (67% vs none; both P < 0.001). There were four times as many complications after RRP (20% vs 5%, P < 0.05), the haemoglobin level at discharge was lower (100 vs 130 g/L, P < 0.005) and the hospital stay longer (3.5 vs 1.2 days; P < 0.05). Most (93%) of VIP and none of the RRP patients were discharged within 24 h (P < 0.001); the duration of catheterization was twice as long after RRP (15.8 vs 7 days; P < 0.05). Positive margin was more frequent after RRP (23% vs 9%, P < 0.05). After VIP, patients achieved continence and return of erections more quickly than after RRP (160 vs 44, and 180 vs 440 days, both P < 0.5). The median return to intercourse was 340 days after VIP but after RRP half the patients have as yet not resumed intercourse at 700 days (P < 0.05).
CONCLUSIONS: The VIP procedure appears to be safer, less bloody and requires shorter hospitalization and catheterization. The oncological and functional results were favourable in patients undergoing VIP.
Studies by year: 2009
Ficarra, V., G. Novara, et al. A prospective, non-randomized trial comparing robot-assisted laparoscopic and retropubic radical prostatectomy in one European institution. BJU Int. 2009 Aug;104(4):534-9. Epub 2009 Mar 5. Abstract.
Rocco, B., D. V. Matei, et al. Robotic vs open prostatectomy in a laparoscopically naive centre: a matched-pair analysis BJU Int. 2009 May 5. Abstract.
Krambeck, A. E., D. S. DiMarco, et al. Radical prostatectomy for prostatic adenocarcinoma: A matched comparison of open retropubic and robot-assisted techniques. Abstract.
Yee DS, Narula N, Amin MB, Skarecky DW, Ahlering TE. Robot-Assisted Radical Prostatectomy: Current Evaluation of Surgical Margins in Clinically Low-, Intermediate-, and High-Risk Prostate Cancer. J Endourol. 2009 Jul 10. Abstract
Studies by year: 2008
Ham, W. S., S. Y. Park, et al. (2008). Open versus robotic radical prostatectomy: A prospective analysis based on a single surgeon's experience. Journal of Robotic Surgery 2(4): 235-241.
Studies by year: 2007
Borin JF, Skarecky DW, Narula N, Ahlering TE. Impact of urethral stump length on continence and positive surgical margins in robot-assisted laparoscopic prostatectomy. 1: Urology. 2007 Jul;70(1):173-7. Abstract.
Badani KK, Kaul S, Menon M. Evolution of robotic radical prostatectomy: assessment after 2766 procedures. Cancer. 2007 Sep 24;110(9):1951-1958. Abstract.
Boris RS, Kaul SA, Sarle RC, Stricker HJ. Radical prostatectomy: a single surgeon comparison of retropubic, perineal, and robotic approaches. Can J Urol. 2007 Jun;14(3):3566-70. Abstract.
Shah KS, Thaly RK, Patel VR. Peri-operative Outcomes of Robotic Assisted Radical Prostatectomy: A Single Surgeon Experience. AUA 2007. Abstract.
Patel AS, Shah KK, Thaly RK, Patel VR. Operative Complications of Robotic assisted Radical Prostatectomy: The Learning curve and Beyond- A single surgeon series. AUA 2007. Abstract.
Patel VR, Thaly R, Shah K. Robotic radical prostatectomy: outcomes of 500 cases. BJU Int. 2007 May;99(5):1109-12. Abstract.
Haliloglu A, Baltaci S, Yaman O. Penile length changes in men treated with androgen suppression plus radiation therapy for local or locally advanced prostate cancer. Findings support observations of decreased penile length after neoadjuvant hormonal therapy plus external beam radiation therapy for local or locally advanced prostate cancer. J Urol 2007 Jan;177(1):128-30. Abstract.
Studies by year: 2006
Menon M, Shrivastava A, Kaul S, Badani KK, Fumo M, Bhandari M, Peabody JO. Vattikuti Institute prostatectomy: contemporary technique and analysis of results. Eur Urol. 2007 Mar;51(3):648-57; discussion 657-8. Epub 2006 Nov 3. Abstract.
Ahlering TE, Skarecky D, Borin J. Impact of cautery versus cautery-free preservation of neurovascular bundles on early return of potency. 1: J Endourol. 2006 Aug;20(8):586-9. Abstract.
Kaul, S, A Savera, K Badani, M Fumo, A Bhandari, M Menon. 2006. Functional outcomes and oncological efficacy of Vattikuti Institute prostatectomy with Veil of Aphrodite nerve-sparing: an analysis of 154 consecutive patients. BJU Int 97:467-72. Abstract.
Studies by year: 2005
Ahlering TE, Eichel L, Chou D, Skarecky DW. Feasibility study for robotic radical Prostatectomy cautery-free neurovascular bundle preservation. Urology. 2005; 65(5): 994-997. Abstract.
Ahlering TE, Eichel L, Skarecky D. Rapid communication: early potency outcomes with cautery-free neurovascular bundle preservation with robotic laparoscopic radical prostatectomy. J Endourol. 2005 Jul-Aug;19(6):715-8. Abstract.
Baxter N, J Tepper, S Durham, D Rothenberger, B Virnig. 2005. Increased Risk of Rectal Cancer After Prostate Radiation: A Population-Based Study. Gastroenterology 2005;128:819-824. Abstract.
Patel V. Robotic-assisted laparoscopic dismembered pyeloplasty. Urology . 2005 Jul;66(1):45-9. Abstract.
Patel VR, Tully AS, Holmes R, Lindsay J. Robotic radical Prostatectomy in the community setting – the learning curve and beyond: initial 200 cases. Urology. 2005 July; 174: 269-272. Abstract.
Studies by year: 2004
Ahlering TE, Eichel L, Edwards RA, Lee DI, Skarecky DW. Robotic radical Prostatectomy: a technique to reduce pT2 positive margins. Urology. 2004; 64: 1224-1228. Abstract.
Ahlering TE, Woo D, Eichel L, Lee DI, Edwards R, Skarecky DW. Robot-assisted versus open radical prostatectomy: a comparison of one surgeon's outcomes. Urology. 2004 May;63(5):819-22. Abstract.
Basillote JB, Ahlering TE, Skarecky DW, Lee DI, Clayman RV. Laparoscopic radical prostatectomy: review and assessment of an emerging technique. Surg Endosc. 2004 Dec;18(12):1694-711. Epub 2004 Oct 26. Abstract
Lee DI, Eichel L, Skarecky D, Ahlering TW. Robotic laparoscopic radical Prostatectomy with a single assistant. Urology. 2004; 63: 1172-1175. Abstract.
Menon M, Hemal AK, Tewari A, Shrivastava A, Bhandari A. The technique of apical dissection of the prostate and urethrovesical anastomosis in robotic radical prostatectomy. BJU Int. 2004 Apr;93(6):715-9. Abstract.
Menon M, Tewari A, Peabody JO, Shrivastava A, Kaul S, Bhandari A, Hemal AK. Vattikuti Institute prostatectomy, a technique of robotic radical prostatectomy for management of localized carcinoma of the prostate: experience of over 1100 cases. Urol Clin North Am. 2004 Nov;31(4):701-17. Abstract.
Studies by year: 2003
Ahlering TE, Skarecky D, Lee D, Clayman RV. Successful transfer of open surgical skills to a laparoscopic environment using a robotic interface: initial experience with laparoscopic radical prostatectomy. J Urol. 2003 Nov;170(5):1738-41. Abstract.
Bentas W, Wolfram M, Jones J, Brautigam R, Kramer W, Binder J. Robotic technology and the translation of open radical prostatectomy to laparoscopy: the early Frankfurt experience with robotic radical prostatectomy and one year follow-up. Eur Urol. 2003 Aug;44(2):175-81. Abstract.
Kaouk JH, Desai MM, Abreu SC, Papay F, Gill IS. Robotic assisted laparoscopic sural nerve grafting during radical prostatectomy: initial experience. J Urol. 2003 Sep;170(3):909-12. Abstract.
Menon M. Robotic radical retropubic prostatectomy. BJU Int. 2003 Feb;91(3):175-6. Abstract.
Menon M, Hemal AK, Tewari A, Shrivastava A, Shoma AM, El-Tabey NA, Shaaban A, Abol-Enein H, Ghoneim MA. Nerve-sparing robot-assisted radical cystoprostatectomy and urinary diversion. BJU Int. 2003 Aug;92(3):232-6. Abstract.
Menon M, Tewari A; Vattikuti Institute Prostatectomy Team. Robotic radical prostatectomy and the Vattikuti Urology Institute technique: an interim analysis of results and technical points.Urology. 2003 Apr;61(4 Suppl 1):15-20. Abstract.
Perer E, Lee DI, Ahlering T, Clayman RV. Robotic revelation: laparoscopic radical prostatectomy by a nonlaparoscopic surgeon. J Am Coll Surg. 2003 Oct;197(4):693-6. Abstract.
Tewari A, Menon M. Vattikuti Institute Prostatectomy: Surgical technique and current results. Curr Urol Rep. 2003 Apr;4(2):119-23. Abstract.
Tewari A, Peabody JO, Fischer M, Sarle R, Vallancien G, Delmas V, Hassan M, Bansal A, Hemal AK, Guillonneau B, Menon M. An operative and anatomic study to help in nerve sparing during laparoscopic and robotic radical prostatectomy. Eur Urol. 2003 May;43(5):444-54. Abstract.
Tewari A, Srivasatava A, Menon M; Members of the VIP Team. A prospective comparison of radical retropubic and robot-assisted prostatectomy: experience in one institution. BJU Int. 2003 Aug;92(3):205-10. Abstract.
Van Velthoven RF, Ahlering TE, Peltier A, Skarecky DW, Clayman RV. Technique for laparoscopic running urethrovesical anastomosis:the single knot method. Urology. 2003 Apr;61(4):699-702. Abstract.
Studies by year: 2002
Menon M, Shrivastava A, Tewari A, Sarle R, Hemal A, Peabody JO, Vallancien G. Laparoscopic and robot assisted radical prostatectomy: establishment of a structured program and preliminary analysis of outcomes. J Urol. 2002 Sep;168(3):945-9. Abstract.
Menon M, Tewari A, Baize B, Guillonneau B, Vallancien G. Prospective comparison of radical retropubic prostatectomy and robot-assisted anatomic prostatectomy: the Vattikuti Urology Institute experience. Urology. 2002 Nov;60(5):864-8. Abstract.
Tewari A, Peabody J, Sarle R, Balakrishnan G, Hemal A, Shrivastava A, Menon M. Technique of da Vinci robot-assisted anatomic radical prostatectomy. Urology. 2002 60(4): 569-572. Abstract.
Other Urology
Cystectomy
Guru KA, Kim HL, Piacente PM, Mohler JL. Robot-assisted radical cystectomy and pelvic lymph node dissection: initial experience at Roswell Park Cancer Institute. Urology. 2007 Mar;69(3):469-74. Abstract.
Rogers CG, Singh A, Blatt AM, Linehan WM, Pinto PA.
Robotic partial nephrectomy for complex renal tumors: surgical technique.
Eur Urol. 2008 Mar;53(3):514-21. Epub 2007 Oct 15.
Minimally invasive surgery to treat kidney cancer that also spares the kidney has become increasingly popular as surgeon expertise has increased and as this approach has demonstrated excellent long-term outcomes in terms of cancer control and kidney function. This report by surgeons from the National Cancer Institute, National Institutes of Health, on their technique concludes that partial nephrectomy (kidney-sparing surgery) performed using the da Vinci System is safe and feasible for select patients with complex kidney tumors. Abstract
Gettman MT, Blute ML, Chow GK, Neururer R, Bartsch G, Peschel R. Robotic-assisted laparoscopic partial nephrectomy: technique and initial clinical experience with DaVinci robotic system. Urology. 2004 Nov;64(5):914-8. Abstract.
Kaul S, Menon M. Robotics in laparoscopic urology. Minim Invasive Ther Allied Technol. 2005;14(2):62-70. Abstract.
Kaul S, Laungani R, Sarle R, Stricker H, Peabody J, Littleton R, Menon M. da Vinci-assisted robotic partial nephrectomy: technique and results at a mean of 15 months of follow-up. Eur Urol. 2007 Jan;51(1):186-91; discussion 191-2. Epub 2006 Jun 21. Abstract.
Klingler DW, Hemstreet GP, Balaji KC. Feasibility of robotic radical nephrectomy--initial results of single-institution pilot study. Urology. 2005 Jun;65(6):1086-9. Abstract.
Phillips CK, Taneja SS, Stifelman MD. Robot-assisted laparoscopic partial nephrectomy: the NYU technique.1: J Endourol. 2005 May;19(4):441-5; discussion 445. Abstract.
Pyeloplasty
Patel V. Robotic-assisted laparoscopic dismembered pyeloplasty. Urology . 2005 Jul;66(1):45-9. Abstract.
Ureteropelvic Junction Obstruction
Atug F, Burgess SV, Castle EP, Thomas R. Role of robotics in the management of secondary ureteropelvic junction obstruction. Int J Clin Pract. 2006 Jan;60(1):9-11. Abstract.
While clinical studies support the effectiveness of the da Vinci® System when used in minimally invasive surgery, individual results may vary. Surgery with the da Vinci Surgical System may not be appropriate for every individual. Always ask your doctor about all treatment options, as well as their risks and benefits.