Robot-assisted radical prostatectomy: Impact of robotic program implementation on clinical and organizational outcomes in a specialized urological hospital

Background. Robot-assisted radical prostatectomy is increasingly used for the surgical treatment of localized prostate cancer; however, its clinical impact should be assessed using perioperative, oncological, functional, and organizational outcomes. Aim. To evaluate the impact of implementing a robot-assisted radical prostatectomy program on clinical and organizational outcomes in a specialized urological hospital. Materials and methods. This retrospective single-center study included 823 patients who underwent radical prostatectomy between 2021 and 2024. The main comparative analysis comprised 269 robot-assisted and 181 laparoscopic procedures. Perioperative, oncological, and functional outcomes were assessed. Multivariate analysis was performed for the principal endpoints. Results. Blood loss ≥200 mL occurred less frequently in robot-assisted than laparoscopic prostatectomy (17.8 % versus 33.1 %; p <0.001), while operative time rarely exceeded 240 min (8.9 % versus 19.3 %; p = 0.001). Median postoperative hospital stay was 12 [9; 14] versus 13 [11; 17] days ( p <0.001). After adjustment, differences in blood loss volume ≥200 mL remained (adjusted odds ratio (aOR) = 0.60; 95 % confidence interval (CI) 0.37–0.97), as well as in operative time >240 min (aOR = 0.52; 95 % CI 0.28–0.96) and duration of hospital stay (–0.85 days; p = 0.030). Positive surgical margins occurred in 11.9 % and 16.6 % of patients, respectively ( p = 0.158), with no independent association with surgical approach. Conclusion. The main benefits of the robotic program were observed in perioperative and organizational outcomes, while oncological radicality remained comparable. Implementation of robot-assisted radical prostatectomy was associated with reduced blood loss, fewer prolonged procedures, and shorter hospitalization without deterioration in oncological outcomes.