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Introduction: Extended lymph node dissection (ELND) compared to limited lymph node dissection (LLND) at time of prostatectomy improves staging and lymph node (LN) yield. The effect on biochemical recurrence (BCR) and survival is less well understood. We sought to evaluate the benefit of robotic ELND and LLND with respect to BCR., Materials and Methods: Between 2008-2012, 584 consecutive men with intermediate or high risk clinically localized adenocarcinoma of the prostate underwent robotic assisted radical prostatectomy (RARP) with concomitant LLND (n = 326) or ELND (n = 258). Survival estimates were made using the Kaplan-Meier method. Log-rank statistic was used for comparison of curves. BCR predictors were determined with multivariable Cox regression analysis. Chi-square and Wilcoxon rank-sum tests were used to compare discrete and continuous variables, respectively, across the two groups., Results: Median follow up for ELND and LLND patients was 46 and 54 months, respectively. ELND yielded more LNs (20 versus 6, p < 0.0001) and had higher node positivity (15.1% versus 3.4%, p < 0.0001). BCR free survival (BCRFS) at 3 and 5 years for ELND and LLND was 85% and 75% (p = 0.01), and 76% and 67% (p = 0.10), respectively. In subgroup analysis, ELND was associated with higher 5 year BCRFS in node-negative patients (84% versus 68%, p = 0.0005) and in intermediate risk patients (93% versus 80%, p = 0.0002). In multivariable analysis, ELND was a significant predictor of BCRFS in node-negative (HR = 0.50, p = 0.003) and intermediate risk patients (HR = 0.54, p = 0.03)., Conclusions: ELND improves LN yield and detection of positive nodes. BCR analysis suggests a reduced risk of PSA failure for robotic ELND in intermediate risk and node-negative patients.

Introduction: As more centers develop robotic proficiency, progressing to a successful robot-assisted partial nephrectomy (RAPN) program depends on a number of factors. We describe our technique, results, and analysis of program setup for RAPN., Materials and Methods: Between 2005 and 2011, 92 RAPNs were performed following maturation of a robotic prostatectomy program. Operating rooms and supply rooms were outfitted for efficient robotic throughput. Tilepro and intraoperative ultrasound were used for all cases. Training and experiential learning for surgeons, anesthesia and nursing staff was a high priority. An onsite robotic technician helped troubleshoot, prepare the room and staff prior to starting surgery, and provide assistance with different robotic models., Results: Average operative time decreased over time from 235 min to 199 min (p = .03). Warm ischemia time decreased from 26 minutes to 23 minutes (p = .02) despite an increased complexity of tumors and operations on multiple tumors. Median estimated blood loss was 150 mL. Average length of hospital stay was 3 days (range 1-9). Average size of lesions was 2.7 cm (range 0.7-8.6). Final pathology demonstrated 71 (77%) malignant lesions and 21 (23%) benign lesions., Conclusions: The addition of a robot-assisted partial nephrectomy program to an institutional robotic program can be coordinated with several key steps. Outcomes from an operational, oncologic, and renal functional standpoint are acceptable. Despite increased complexity of tumors and treatment of multiple lesions, operative and warm ischemia times showed a decrease over time. An organizational model that involves the surgeons, anesthesia, nursing staff, and possibly a robotic technical specialist helps to overcome the learning curve.

Introduction/objective: Simple prostatectomy continues to be an effective surgical option for patients with symptomatic high volume benign prostatic hyperplasia. Recent trends towards minimally invasive urologic surgery, in particular for prostate cancer, have created surgical alternatives with additional potential benefits. We report on the feasibility of robot-assisted retropubic prostatectomy., Materials and Methods: This series consists of three cases of simple prostatectomy performed through a robot-assisted retropubic (Millin) approach at two institutions. All patients had preoperative bothersome lower urinary tract symptoms with two patients presenting in urinary retention. Average preoperative transrectal ultrasound estimated prostate volume exceeded 300 cm3. All patients were ruled out for malignancy., Results: Average age for the patient group was 76.7 years with mean prostate specific antigen (PSA) of 25.1. Estimated blood loss averaged 558 ml (150-1125) and mean operative time was 211 minutes (178-230). One patient had a simultaneous inguinal hernia repair performed. The patient with the largest prostate required incision extension for removal of specimen. There were no acute intraoperative or perioperative complications. Mean hospital stay was 1.3 days and one patient required blood transfusion. Average adenoma weight was 301 grams (66-640). One patient developed bladder neck contracture several months postoperatively., Conclusions: Robotic-assisted retropubic simple prostatectomy is a reasonable and safe alternative to an open technique. Faster recuperation and reduced blood loss are potential benefits to this approach. The longer operative time and extraction incision for very large prostates (>200 gms) may offset some of the advantages of the minimally invasive method.