Evidence-based evolution of our robot-assisted laparoscopic prostatectomy (RALP) technique through 13,000 cases
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ORIGINAL ARTICLE
Evidence‑based evolution of our robot‑assisted laparoscopic prostatectomy (RALP) technique through 13,000 cases Kulthe Ramesh Seetharam Bhat1 · Marcio Covas Moschovas1 · Fikret Fatih Onol1 · Travis Rogers1 · Sunil Sandadi Reddy1 · Cathy Corder1 · Shannon Roof1 · Vipul R. Patel1 Received: 19 September 2020 / Accepted: 5 October 2020 © Springer-Verlag London Ltd., part of Springer Nature 2020
Abstract Robot-assisted laparoscopic radical prostatectomy (RALP) has become the standard of surgical care in the USA and around the world. Over the past 18 years, we have performed 13,000 radical prostatectomies, and our surgical technique has evolved over time. We discuss this evolution and how it has helped us achieve optimal patient outcomes. Keywords Prostate cancer · Radical prostatectomy · Robotic prostatectomy · Robotics · Minimally invasive · Surgical technique · High volume · Single surgeon · Apex sparing · Periurethral suspension · Neurovascular bundle · Nerve spare · Posterior reconstruction · Vesicourethral
Introduction Robot-assisted laparoscopic radical prostatectomy (RALP) has become the standard of surgical care in the USA and around the world. In 2013, 85% of radical prostatectomies (RPs) in the USA were robot-assisted, and the numbers are increasing [1]. The advantages of robotic technology in RALP are magnification (× 10), three-dimensional vision, and wristed instruments which allow challenging dissections and precise suture placement. RALP offers several advantages over traditional open methods, including decreased blood loss, shorter hospital stays, and decreased perioperative morbidity [2]. Our experience with robot-assisted laparoscopic radical prostatectomy (RALP) began in 2002, and has evolved quite significantly during the 13,000 cases we have performed. We have continually refined our technique to improve functional and oncological outcomes. With growing experience and the addition of new features to more recent da Vinci® consoles, our technique has seen several modifications over the last
* Kulthe Ramesh Seetharam Bhat [email protected]; [email protected] 1
Global Robotics Institute, Advent Health Celebration Health, Suite 200, 410 Celebration Place, Celebration, FL 34747, USA
decade. In this paper, we aimed to describe the evolution of our RALP technique over 13,000 cases.
Development of surgical technique Between January 2002 and February 2020, 13,000 patients with local or locally advanced prostate cancer underwent RALP by a single surgeon (VP). The initial 2000 cases were performed with the standard da Vinci® console, whereas subsequent 2000, 4000, and 5000 cases were done using the da Vinci® S, Si, and Xi console, respectively (Fig. 1). We utilized a 6-port, transperitoneal approach in all cases [3]. Recently, we also performed 60 cases with the da V inci® SP system. From the beginning, our approach to the learning and technique modification curve was an evidence-based prospective/retrospective approach. In the beginning, we analyzed our ou
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