Can robotic assisted laparoscopic prostatectomy be recommended to obese patients?

Experienced robotic surgeons report lower estimated blood loss (EBL) and transfusion rates with similar clinical outcomes for robotic assisted laparoscopic radical prostatectomy (RALP) compared to open radical retropubic prostatectomy (RRP). We reviewed our experience with RALP to investigate how to counsel overweight and obese patients being considered for RALP regarding risk of major perioperative complications, oncological outcomes, and short-term recovery. We reviewed the data on 1,513 patients who underwent RALP by one of four experienced robotic surgeons between June 2003 and November 2006. These patients were categorized as normal, overweight, obese, and severely obese based on body mass index (BMI). Of these patients, 361 (23.9%) had a BMI under 25, 794 (52.5%) had a BMI between 25 and 30 (overweight), 290 (19.2%) had a BMI between 30 and 35 (obese), and 68 (4.5%) had a BMI over 35 (severely obese). Records were examined and analyzed with respect to BMI for major intra- and perioperative complications, operative time, margin status, EBL, transfusion rates, and length of hospital stay. Increasing BMI was associated with longer operative time, with mean operative times of 2.7, 2.8, 3.1, and 3.3 h for normal, overweight, obese and severely obese patients, respectively (P < 0.0001). Higher blood loss, though not clinically significant, was also associated with increased BMI, with obese and severely obese patients losing a median of 250 mL of blood compared to 200 mL in overweight and non-overweight patients (P < 0.0001). Transfusion rates, intra- and perioperative complications, margin status, and length of stay were not found to be associated with BMI group. Robotic assisted laparoscopic radical prostatectomy in experienced hands can be safely recommended to eligible patients regardless of BMI status.