Real Life Comparative Analysis of Robotic Assisted versus Laparoscopic Radical Prostatectomy in a Single Centre and Single Surgeon Experience

Background: The advantage of a robotic assisted (RARP) over a laparoscopic (LRP) approach in radical prostatectomy (RP) remains to be demonstrated. Aim of the study is to use a homogeneous population in real life and single surgeon surgery, to analyze the oncological and functional results based on the type of the surgical approach. Methods: This is a prospective trial on non-metastatic prostate cancers (PC) patients considered after multidisciplinary decision to RP, using RARP or LRP. A real-life setting was analyzed at our Urological Departments, using homogeneous criteria for the management of PC cases and a one surgeon experience on 444 cases (284 LRP and 160 RARP) .Results: Mean operative time was significantly lower in RARP (173.3344.3 min) than in LRP (153.2125.1 min) (p0.001). In cases submitted to an extended lymph node dissection (eLND), the mean number of lymph nodes removed was 15.167.83 and 19.834.78 respectively in LRP and RARP procedures (p0.001), but positive lymph nodes (pN1) were similarly found in 15.8% of LRP patients and 13.6% of RARP patients (p=0.430). Surgical margins (SM) positivity was not significantly higher in RARP group (20.0%) when compared to LRP group (15.9%) (p=0.145). During the postoperative follow-up, a biochemical recurrence (BCR) was detected in 14.4% and 7.5% of cases in the LRP and RARP group respectively (p=0.014). Better results of PAD test at 3-month interval using RARP approach (mean pad weight 75.57122 grams and 1442 grams respectively in LRP and RARP (p0.01)) were described. Conclusions: In the comparison between RARP and LRP approach, a clear advantage of the robotic approach is a significant reduction in operating times, days of hospitalization and postoperative catheterization compared to laparoscopic surgery. It is not possible to describe any certain oncological advantage both in terms of surgical margins and pathological lymph nodes removed. In RARP cases a reduction to the limit of significance is described in terms of biochemical recurrence. RARP produces a more rapid recovery of urinary continence at 3 months postoperatively without significant advantages in terms of erective potency recovery.