Every setback is a setup for a comeback: 3D laparoscopic radical prostatectomy after robotic radical prostatectomy.

Abstract

PURPOSE: To assess whether previous experience in robotic surgery has a role in the transition to 3D laparoscopy and influences the perioperative results and short term oncological and functional outcomes of the first patients that undergo laparoscopic radical prostatectomy (LRP). METHODS: We analyzed 248 patients that underwent robotic radical prostatectomy (RALP) between 2009-2015 and 98 patients that underwent 3D HD LRP from 2015-present in our department. The procedures were performed by the same two surgeons, who crossed from open to robotic surgery, and afterwards to 3D laparoscopy. RESULTS: The patients in the study groups were comparable in terms of age, pre-operative PSA levels, clinical staging and D'Amico risk groups. The operative time was significantly shorter in favor of the laparoscopic approach (a difference of 110 min, p<0.0001). The overall rate of positive surgical margins was similar, with the biggest difference from 40.8% to 25% in pT3 patients in favor of the laparoscopic approach. The mean time to catheter removal was 7 days for RALP and 8 days for LRP. We did not identify any significant difference between the two groups in terms of biochemical recurrence, continence or potency at 3 and 6 months after the procedure. CONCLUSIONS: Previous experience in robotic surgery ensured a fast transition to 3D laparoscopic approach for radical prostatectomy, with comparable oncologic and functional outcomes, but with a shorter operative time and reduced costs.