Robotic radical prostatectomy: operative technique, outcomes, and learning curve.

OBJECTIVE: To report the operative technique, oncologic and therapeutic outcomes, and learning curve from our initial series of over 140 patients treated by robotic radical prostatectomy. METHODS: Between January 2003 and May 2005, 143 patients with clinically localized prostate cancer underwent a robotic radical prostatectomy. Prospective data collection included patient age, body mass index (BMI), clinical T stage, biopsy Gleason score, and prostate-specific antigen (PSA). Operative outcome measures included operative time, estimated blood loss (EBL), and complications. Post-operative outcomes were length of hospital stay, catheter duration, pathology, margin status, biochemical recurrence, and return of continence. RESULTS: Mean operative time was 241 minutes with an EBL of 274 mL. Five patients (3%) required conversion to open surgery. The average hospitalization was 1.8 days, and Foley catheters were removed after 8.9 days. Twenty-four of 141 men (17%) had a positive surgical margin, with a decrease from 23% in the first half of our experience to 11% in the latter half. Patients with an extracapsular extension had a significantly higher positive surgical margin rate than did those with organ-confined disease (47% vs 15%). Over 40% of the positive margins were located posteriorly. At a mean follow-up of 11 months, 96% of patients had a PSA <0.2 ng/mL. The median time to complete continence was 3.5 months, and over 95% of patients were fully continent at 1 year. CONCLUSION: Robotic radical prostatectomy is an effective treatment modality for clinically localized prostate cancer. Although a learning curve needs to be overcome, patients experienced benefits in convalescence with early oncologic and functional outcomes comparable to those of the open approach. Longer-term results are needed; however, patient outcomes in our series are encouraging.