Document Type

Thesis

Publication Date

Spring 5-2-2011

Abstract

Introduction: The goal of laparoscopic prostatectomy is to excise the cancer completely, provide good urinary continence post-operatively, and maintain the ability to have erections after the surgery, if present prior to surgery. Robotic assisted laparoscopic prostatectomy is a procedure performed with the assistance of a surgical robot that provides improved magnified vision in order to help achieve these goals while minimizing surgical incisions. With experience in performing this type of procedure, surgical doctors should be able to reduce operating time, blood loss, and margin error.

Methods: We reviewed the records of 200 patients who underwent treatment between July 2008 and February 2010. The first group of 100 patients ranged from July 2008 to February 2009 and the second group ranged from July 2009 to February 2010. Patients within each group were divided according to their pathological stages (pT2 and pT3) in a chronological time line. The percentages of patients with margin errors were then calculated for pT2, pT3, and an overall combination of pT2 + pT3 for each group. The mean blood lost (in cc) and mean operative time (in minutes) were also calculated within each group. We then created a line graph for mean blood lost and mean operative time against the operative time line according to pT2, pT3, and an overall for both groups. We also took the mean for age; mean Gleason Scores for pT2, pT3, and an overall; percentage of patients with Hernia repair, percentage with PLN dissection for pT2, pT3, and an overall; mean number of length of days stayed post operative; mean number of days until removal of Foley; mean number of days until JP removal; and percentage of patients with incontinence, erectile dysfunction, and stricture within a 1 year period post operative. P-value and correlation (r) were also calculated.

Results: Mean patient age was 61 years with an average Gleason score of 6.64 for pT2 (p < 0.0001), 6.97 for pT3 (p-value < 0.0001), and 6.69 for a combination of pT2 and pT3 (p < 0.0001). 1.5% of the patients had hernia repair, 7.88% with pT2 had PLN dissection, 33.33% of pT3 had PLN dissection, and an overall of 12.12% had PLN dissection. Patients stayed an average of 2.65 days post-operatively for Group 1 and 2.01 days for Group 2 (P-value = 0.0004). The average time for JP drain removal was about 3.11 days for Group 1 and 1.87 days for Group 2 (P-value = 0.0023). The average time for Foley catheter removal was 17.5 days in Group 1 and 12.7 days in Group 2 (P-value <0.0001). 74.73% of patients were incontinence, 90.71% had erectile dysfunction, and 1.51% had stricture. For group 1, 16.46% of patients with pT2 had margin errors, 44.44% for pT3, and an overall of 21.65%. For group 2, 26.74% of patients with pT2 had margin errors, 57.14% for pT3, and an overall of 31%. The mean blood loss for the first group of patients was 596.28 cc, while the second group had a mean blood loss of 387.37 cc with a negative correlation (r = -0.24) between mean blood loss and operative date (P-value = 0.0003). For operative time, the first group has a mean operative time of 265.89 minutes while the second group had a mean operative time of 224.42 minutes with a negative correlation (r = -0.31) between operative time and operative date (P-value = 0.001).

Conclusion: In this study, there is noticeable decreased in estimated blood lost and operative time for the second group compared to the first group overtime. However, the percent with margin error were unexpectedly higher in the second group compared to the first group.

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Medical/Health

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