Robotic radical prostatectomy in 93 cases: Outcomes of the first ERUS robotic urology curriculum trained surgeon in Turkey

Özet

Objective: This study presents the surgical, oncological, and functional outcomes of the first 93 robotic radical prostatectomy (RARP) procedures performed in Erzurum, Turkey. These procedures were performedby a single surgeon who had completed the European Association of Urology Robotic Urology Section(ERUS) RARP curriculum in an ERUS-certified training center in Ankara.Material and methods: The study present the results of 93 RARP procedures performed by a single surgeon. The surgeon performing the operations completed an ERUS training program structured for RARPby two robotic surgeons holding ERUS training certificates in an ERUS-approved academic robotic surgerytraining center in Ankara.The RARP cases performed by the surgeon after completion of the training between April 2016 and August 2018 were retrospectively evaluated.Results: The mean patient age was 63.62±7.04 years, and the mean preoperative serum prostate-specificantigen level was 8.34±4.96 ng/mL. Preoperatively, 82 and 4 patients had prostate biopsy Gleason scoresof 3+3 and 4+3, respectively. Bilateral neurovascular bundle (NVB) sparing, unilateral NVB-sparing, andnon-NVB-sparing surgery were performed in 21, 13, and 59 cases, respectively. The mean prostate weightwas 85.34±47.57 g. Posterior rhabdosphincter reconstruction was performed in 60 (64.5%) cases. Meanconsole time, intraoperative blood loss, duration of hospital stay, and urethral catheter removal time were170.49±36.50 min, 100.70±34.08 cc, 6.84±2.28 days, and 7.40±3.11 days, respectively. During the perioperative period (0–30 days), five minor (prolonged drain output, n=3; rectocele, n=1; gout arthritis, n=1)and six major (inguinal hernia, n=1; incisional hernia, n=2; anastomotic urinary leakage, n=2; myocardialinfarction, n=1) complications were identified. No complication was detected during postoperative days31–90. Postoperative pathological stages included pT2a, pT2b, and pT2c disease in 77 (82.8%), 9 (9.7%), and7 (7.5%) patients, respectively. The positive surgical margin (SM) rate was 10.7% (n=10), including patientswith pT2a (n=6) and pT2c (n=2) diseases. Eleven (11.8%) patients underwent pelvic lymph node (LN) dissection. The mean LN yield was 16.45±4.29. The mean length of follow-up was 11.17±8.01 months. Biochemical recurrence was observed in two patients, one of whom received maximal androgen blockage (MAB), andthe other one received pelvic radiotherapy+MAB. All the patients with at least one-year follow-up (n=48,51.6%) were fully continent (0 pads/day). Of the 40 (43%) patients with no preoperative erectile dysfunction(ED) and with at least three-month follow-up, 18 (45%) had no ED, with or without any additional medication including phosphodiesterase-5 (PDE5) inhibitors.Conclusion: RARP is a safe minimally invasive procedure with acceptable morbidity, excellent operative,pathological and oncological outcomes, and satisfactory functional results. The ERUS RARP curric