Comparison of intraoperative outcomes using the new and old generation da Vinci® robot for robot-assisted laparoscopic prostatectomy

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Study Type – Therapy (case series)Level of Evidence 4OBJECTIVE• To review and compare intraoperative outcomes for robotic prostatectomy procedures performed on two generations of the da Vinci robotic surgery platform.MATERIAL AND METHODS• We reviewed 100 consecutive robotic prostatectomy cases and compared intraoperative outcomes for procedures randomly performed on either the da Vinci S robot or first-generation standard robot.• Baseline demographic data and intra-operative variables potentially impacting outcomes were reviewed and compared between the two groups.RESULTS• Mean total operative time was 191 min using the standard da Vinci robot (range 132–266) versus 169 min with S robot (range 98–230), representing a mean difference of 22 min (P = 0.002).• This difference was statistically significant despite no difference in mean patient BMI of 30.6 (range 19–51) for standard versus 29.3 (range 21–37) for S (P = 0.31), no difference in mean prostate size of 54.6 g (range 26–101) for standard versus 57.3 g (range 32–151) for S (P = 0.55), and no difference in frequency of nerve-sparing (P = 0.99).• There was also no difference in the portions of procedues performed by residents, which in some cases was none and some the entire procedure, but the standard was more often used for the surgeon's first case of the day (P = 0.006).• There was no difference in blood loss (P = 0.08), positive margins (P = 0.87), or mean number of lymph nodes removed (10.7 vs 10.6).CONCLUSIONS• Both generations of da Vinci robotic technology are equally effective for PALP, but the S robot appears to allow shorter procedure times.• Further such evaluations are necessary to guide institutions and public policy decision-makers on investments in newer generations of robotic technology as incremental advances continue.

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