Prospective comparison of short-term convalescence: Laparoscopic radical prostatectomy versus open radical retropubic prostatectomy

Objectives: To evaluate and compare prospectively the convalescence of patients after laparoscopic radical prostatectomy (LRP) and open radical retropubic prostatectomy (RRP) in a standardized clinical care pathway at a single institution by two surgeons of equal experience and training. Methods: The study included all 60 patients undergoing LRP and RRP by two fellowship-trained surgeons in their first year of practice. The postoperative care of these patients was uniform and standardized. The medical records were reviewed and convalescence data obtained by an independent urologist and physician's assistant. Results: Of the 60 patients, 24 underwent RRP and 36 underwent attempted LRP; 3 patients were converted from LRP to RRP. The differences in mean age, preoperative prostate-specific antigen level, Gleason score, in-hospital morphine equivalent requirement, time to oral intake, and hospital stay were not statistically significant between the LRP and RRP groups. The operating room time was significantly longer (5.8 ± 1.2 hours versus 2.8 ± 0.55 hours, P <0.0001) and the estimated blood loss was significantly lower in the LRP group (533 ± 212 mL versus 1473 ± 768 mL, P <0.0001) than in the RRP group. Pain medication use at home was significantly less in the LRP group (9 ± 13 versus 17 ± 15 oxycodone tablets, P <0.04), as was the time to complete convalescence (30 ± 18 days versus 47 ± 21 days, P <0.002). Conclusions: Although LRP took almost twice as long to complete as RRP in our initial clinical experience, the patients had a similar hospital course. LRP patients required less pain medication after discharge and had a shorter time to complete recovery than did RRP patients. Additional studies are needed to address long-term cancer control, potency, and continence outcomes to determine the precise role of LRP in the treatment of men with clinically localized prostate cancer.