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Contemporary Comparison of Open to Robotic Prostatectomy at a Veteran’s Affairs Hospital
- Source :
- Military Medicine. 184:e330-e337
- Publication Year :
- 2018
- Publisher :
- Oxford University Press (OUP), 2018.
-
Abstract
- Among veterans, prostate cancer is the most common malignancy and has a higher incidence compared to the rest of the nation. No study has compared the effectiveness of Robotic-assisted-laparoscopic radical prostatectomy (RALP) vs. open radical prostatectomy (ORP) in the Veteran's Affairs (VA) hospital setting during the adoption of RALP.Institutional Review Board approval was obtained. Retrospective review was completed on Veterans with prostate cancer who underwent ORP or RALP from March 2011 to January 2017 during the introduction of RALP at one VA hospital. Perioperative and functional outcomes between ORP and RALP were compared as well as between the initial 50 and final 53 RALPs.Among 91 ORPs and 153 RALPs, RALP had significant reductions in blood transfusions [2(1.3%) vs. 44(40%), p0.001], length of stay [2 days(1-2) vs. 3 days(2-4), p0.001], Clavien grade2 complications [1(0.7%) vs. 20 (22.0%), p0.001], urine leak [2(1.3%) vs. 11 (12.1%), p0.001], and ICU readmissions [0(0%) vs. 3(3.3%), p0.001]. There were no significant differences in positive margin status or functional outcomes. Compared to the first 50 cases, the last 53 RALPs demonstrated a shorter operative time (349 vs. 292 min, p0.001), lower EBL (300 vs. 150 mL, p0.001), more frequent 1-day length of stay (34% vs. 60%, p = 0.02), and fewer composite adverse events (82% vs. 51%, p = 0.004). Operative time for the final 53 RALPs (292 minutes) was shorter than that of ORP (325 minutes, p = 0.013).During the introduction of RALP at one VA hospital, RALP was associated with several improved parameters compared to ORP and similar operative times were noted after the first 100 cases of RALPs. RALP is safe to introduce in a VA setting without compromising outcomes.
- Subjects :
- Male
medicine.medical_specialty
Blood transfusion
medicine.medical_treatment
0211 other engineering and technologies
02 engineering and technology
law.invention
03 medical and health sciences
Postoperative Complications
0302 clinical medicine
Robotic Surgical Procedures
law
medicine
Humans
030212 general & internal medicine
Laparoscopy
Adverse effect
Aged
Retrospective Studies
Veterans
Prostatectomy
021110 strategic, defence & security studies
medicine.diagnostic_test
business.industry
Incidence (epidemiology)
Public Health, Environmental and Occupational Health
Prostatic Neoplasms
General Medicine
Perioperative
Middle Aged
Intensive care unit
United States
Surgery
United States Department of Veterans Affairs
Treatment Outcome
Prostate neoplasm
business
Subjects
Details
- ISSN :
- 1930613X and 00264075
- Volume :
- 184
- Database :
- OpenAIRE
- Journal :
- Military Medicine
- Accession number :
- edsair.doi.dedup.....3f9d1b70f9d71c2f1868657be7f2f473