Transitioning from open to laparoscopic radical prostatectomy: Safety and feasibility during the learning curve
TL;DR
LRP can be safely adopted during the learning curve without compromising early oncological or functional outcomes, as well as surgical, tumor-related, and functional outcomes during the adaptation period.
Abstract
Aim: This study aimed to analyze the challenges encountered during the transition from open retropubic radical prostatectomy (RRP) to laparoscopic radical prostatectomy (LRP) at a long-standing center of open RRP experience and to evaluate surgical, tumor-related, and functional outcomes during the adaptation period.Material and Methods: 12 LRP and 21 RRP patients operated between January-June 2025 were prospectively collected and retrospectively analyzed. Perioperative parameters, pathological outcomes, and functional results were analyzed. Continence was assessed using ICIQ-SF scores and defined as score ≤5 or complete absence of pad use. Potency was evaluated using IIEF-5 scores, with potency defined as score ≥17. Complications were stratified according to Satava and Clavien-Dindo systems.Results: Baseline demographic and clinicopathological characteristics were comparable. The LRP group demonstrated significantly reduced estimated blood loss (660.5±221.4 vs 1100±528.1 mL, p=0.021), lower transfusion rate (25.0% vs 71.4%, p=0.027), shorter drain removal time (median 2 vs 4 days, p=0.002), and reduced length of hospital stay (median 3 vs 4 days, p=0.006). Perioperative complications were similar (16.7% vs 9.5%, p=0.708). Positive surgical margin rates (33.3% vs 66.7%, p=0.137) and biochemical recurrence rates (8.3% vs 4.8%, p=0.685), showed no significant differences. The LRP group achieved significantly higher early continence at 1st month (33.3% vs 4.8%, p=0.029) and higher IIEF-5 scores at 3rd (10.5 vs 8, p=0.020) and 6th months (13.5 vs 9, p=0.030).Conclusion: LRP can be safely adopted during the learning curve without compromising early oncological or functional outcomes.