Selection criteria for open versus robotic prostatectomy?

[littleemma]

I am from a non-surgical specialty.

I appreciate if you guys could tell me what is the selection criteria for open versus robotic prostatectomy?

I know all patients should have localized prostate cancer, good performance and be a surgical candidate.

Does obesity, BMI play a role?

Thank you very much!

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[cpants]

I am from a non-surgical specialty.

I appreciate if you guys could tell me what is the selection criteria for open versus robotic prostatectomy?

I know all patients should have localized prostate cancer, good performance and be a surgical candidate.

Does obesity, BMI play a role?

Thank you very much!

Open or robotic approaches are acceptable for any patient in whom surgery is indicated. Outcomes are pretty similar for either approach.

The nice thing about an open approach is that you stay extraperitoneal. Patients with hostile abdomens -- ie. previous intraabdominal catastrophe, multiple prior surgeries -- may be a better candidate for an open approach. Obesity does not necessarily play a role and will make either approach more difficult.

 

[DoctwoB]

Open or robotic approaches are acceptable for any patient in whom surgery is indicated. Outcomes are pretty similar for either approach.

The nice thing about an open approach is that you stay extraperitoneal. Patients with hostile abdomens -- ie. previous intraabdominal catastrophe, multiple prior surgeries -- may be a better candidate for an open approach. Obesity does not necessarily play a role and will make either approach more difficult.

Unless you go extraperitoneal robo . . .

But yeah they are both good surgeries. If it were me or my dad I’d go with the best and/or highest volume surgeon in the area and whatever approach he or she is most comfortable with.

 

[littleemma]

Really appreciate you two's clarification on this! It is very helpful!

 

[mestielest]

As other colleagues said, none of them is clearly inferior or superior to the each other.

However, from my experience, I think the open retropubic route is more challenging in obese patients.

 

[Osteoth]

Unless you go extraperitoneal robo . . .

But yeah they are both good surgeries. If it were me or my dad I’d go with the best and/or highest volume surgeon in the area and whatever approach he or she is most comfortable with.

Didn't even realize you could go extra-peritoneal with a RALP. In terms of positioning the robot, how do do you maintain depth to get all the arms in? Do you still go 4 + an assistant?

 

[DoctwoB]

Didn't even realize you could go extra-peritoneal with a RALP. In terms of positioning the robot, how do do you maintain depth to get all the arms in? Do you still go 4 + an assistant?

you enter and develop the space posterior to the rectus muscle within the sheath with a dissecting balloon like in a lap inguinal hernia repair. You then place your ports (usually 4 plus an assistant) into that space taking care to avoid entering the peritoneum. It’s tricky because you have less space to put all your ports/assistant but it lets you avoid peritoneal adhesions/ having bowel in your face, etc. it also lets you use less trendelenberg for patients that would have trouble tolerating it.