Peri-operative outcomes of open, laparoscopic and robotic simple prostatectomy

Abstract

Objective: To compare peri-operative outcomes and trends in open (OSP), laparoscopic (LSP) and robot-assisted simple prostatectomy (RASP). Materials and Methods: We used German Nationwide Inpatient Data (GRAND), provided by the Research Data Centre of the Federal Bureau of Statistics, and performed multiple patient-level analyses. Results: Between 2013 and 2023, 46 234 simple prostatectomies were performed in Germany for benign prostatic hyperplasia without concomitant bladder stones. Of these, 44 194 (96%) were performed with an open, 724 (1%) with a laparoscopic, and 1335 (3%) with a robotic approach. Among patients undergoing OSP, 11 755 (27%) cases were performed with a transcapsular and 32 439 (73%) with a transvesical approach. We compared transcapsular OSP vs RASP and LSP. The adoption of RASP increased exponentially during the period studied, while the use of OSP gradually declined, and that of LSP remained stable. In multivariable regression analyses, in-hospital transfusions were lower for LSP (6.5%; odds ratio [OR] 0.46, 95% confidence interval [CI] 0.34–0.62, P < 0.001) and RASP (7.3%; OR 0.58, 95% CI 0.47–0.72, P < 0.001) compared to OSP (13%). In-hospital urinary retention was significantly less frequent after LSP (4.6%; OR 0.46, 95% CI 0.32–0.65, P < 0.001) and RASP (6.4%; OR 0.68, 95% CI 0.54–0.85, P < 0.001) compared to OSP (9.3%). The median (interquartile range) hospital stay was 9 (8–12) days for OSP, 7 (6–9) days for RASP (P < 0.001) and 4 (4–7) days for LSP (P < 0.001). Transcapsular OSP was associated with a lower risk of intensive care unit admission (P < 0.001) and shorter hospital stay (P < 0.001) compared to transvesical OSP. Conclusion: Our results showed that RASP is rapidly growing and offers better peri-operative outcomes compared to OSP.