Randomized comparison between laparoscopic and robot-assisted nerve-sparing radical prostatectomy

Anastasios D. Asimakopoulos, Clovis T. Pereira Fraga, Filippo Annino, Patrizio Pasqualetti, Adriano A. Calado, Camille Mugnier

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Abstract

Introduction. Lack of randomized controlled trials (RCTs) that compare pure laparoscopic radical prostatectomy (LRP) with robot-assisted laparoscopic radical prostatectomy (RALRP) is an important gap of the literature related to the surgical treatment of the clinically localized prostate cancer (PCa). Aim. To provide the first prospective randomized comparison on the functional and oncological outcomes of LRP and RALRP for the treatment of the clinically localized PCa. Methods. Between 2007 and 2008, 128 consecutive male patients were randomized in two groups and treated by a single experienced surgeon with traditional LRP (Group I-64 patients) or RALRP (Group II-64 patients) in all cases with intent of bilateral intrafascial nerve sparing. Main Outcome Measures. Primary end point was to compare the 12 months erectile function (EF) outcomes. Complication rates, continence outcomes, and oncological results were also compared. The sample size of our study was able, with an adequate power (1-beta>0.90), to recognize as significant large differences (above 0.30) between incidence proportions of considered outcomes. Results. No statistically significant differences were observed for operating time, estimated blood loss, transfusion rate, complications, rates of positive surgical margins, rates of biochemical recurrence, continence, and time to continence. However, the 12-month evaluation of capability for intercourse (with or without phosphodiesterase type 5 inhibitors) showed a clear and significant advantage of RALRP (32% vs. 77%, P17 (38% vs. 63%) were also significantly higher for RALRP (P=0.0002 and P=0.008, respectively). Conclusions. Our study offers the first high-level evidence that RALRP provides significantly better EF recovery than LRP without hindering the oncologic radicality of the procedure. Larger RCTs are needed to confirm if a new gold-standard treatment in the field of RP has risen.

Original languageEnglish
Pages (from-to)1503-1512
Number of pages10
JournalJournal of Sexual Medicine
Volume8
Issue number5
DOIs
Publication statusPublished - May 2011

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Keywords

  • Erectile Function Outcome of Prostate Cancer Surgery
  • Laparoscopic Prostatectomy
  • Potency
  • Prostate Cancer
  • Prostatectomy
  • Robot-Assisted Prostatectomy

ASJC Scopus subject areas

  • Urology
  • Obstetrics and Gynaecology
  • Reproductive Medicine

Cite this

Asimakopoulos, A. D., Pereira Fraga, C. T., Annino, F., Pasqualetti, P., Calado, A. A., & Mugnier, C. (2011). Randomized comparison between laparoscopic and robot-assisted nerve-sparing radical prostatectomy. Journal of Sexual Medicine, 8(5), 1503-1512. https://doi.org/10.1111/j.1743-6109.2011.02215.x