NE-AUA 2006 Annual Meeting, September 28 - 30, 2006, The Westin Hotel & Rhode Island Convention Center Providence, Rhode Island
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Complex Urological Oncological Surgeries can be Performed Using Minimally Invasive Robotic or Laparoscopic Methods with Similar Early Perioperative Results Compared to Conventional Open Methods
Tony Mammen, MD1, K.C. Balaji, MD2.
1University of Nebraska Medical Center, Omaha, NE, USA, 2University of Massachusetts Memorial Medical Center, Worcester, MA,

Background: Robotic and laparoscopic surgical methods (RLM) are being increasingly used to perform complex urological oncological procedures. We compared the early perioperative outcomes in a cohort of consecutive patients undergoing complex urological oncological surgeries by either RLM or open methods (OM) at a single institution.
Methods: The relevant data on 279 consecutive patients undergoing complex urological oncological procedures from Sept 2000 to June 2005 was entered into a Microsoft Access™ database and queried. Continuous variables were compared using the Wilcoxon rank sum test and categorical variables were compared using Fisher’s exact test. P values were compared to a significance level of 0.05.
Results: Of the 279 patients who underwent primary urological oncology surgeries, OM and RLM was used in 139 (49.8%) and 140 (50.2%) of patients, respectively. The age, gender, and body mass index between the 2 groups were comparable (p>0.05). Six perioperative mortalities (2.2%) occurred, with 3 (2.1%) in OM and 3 (2.2%) in RLM group. A total of 41 (14.7%) perioperative complications occurred in the entire cohort with 17 (12.2%) occurring in the OM group compared to 13 (9.3%) in the RLM group. Radical prostatectomy, cystectomy, radical or partial nephrectomy was performed in (OM, RLM) 117 (70,47), 52 (33, 19), 86 (21,65) and 24 (15, 9) patients, respectively. Within these subgroups there were no statistical differences in perioperative complication rates, drop in hemoglobin, or change in serum creatinine between OM and RLM (p>0.05). The operative time was significantly longer in patients undergoing radical prostatectomy and radical cystectomy by RLM compared to OM (p<0.05). Estimated blood loss was significantly lower in patients undergoing radical prostatectomy, radical nephrectomy, and radical cystecomy when performed by RLM compared to OM (p<0.05). Hospital stay was significantly shorter in patients undergoing radical prostatectomy and radical cystectomy by RLM compared to OM (p<0.05).
Conclusions: Primary urological oncological surgeries can be performed without significantly increased perioperative complications by RLM compared to OM. RLM is associated with significantly decreased blood loss in the radical prostatectomy, radical nephrectomy, and radical cystectomy groups. The significantly prolonged operative time associated with radical prostatectomy and radical cystectomy by RLM may reflect the learning curve for these procedures.


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