Intraoperative blood loss and transfusion requirements for robotic-assisted radical prostatectomy versus radical retropubic prostatectomy

Objectives. To compare intraoperative blood loss, perioperative hematocrit, and transfusion requirements in patients undergoing radical retropubic prostatectomy (RRP) versus robotic-assisted laparoscopic prostatectomy (RALP) by a single surgeon. Methods. During a 14-month period, 279 patients with localized carcinoma of the prostate were prospectively enrolled in this comparative study. The decision of which surgical approach to use was by patient choice. Of the 279 patients, 176 underwent RALP and 103 underwent RRP. The serum hematocrit was obtained preoperatively and 24 hours postoperatively in all patients. The intraoperative blood loss was recorded, and transfusion requirements were noted. Results. Patients in the RALP group had significantly less intraoperative blood loss compared with the RRP group (mean 191 mL versus 664 mL, P <0.001). Additionally, the difference in the discharge hematocrit (36.8% versus 32.8%, P <0.001) and the mean perioperative change in hematocrit (8.0% decrease versus 10.7% decrease, P <0.001) were significant between the RALP and RRP groups, respectively. Three patients in the RRP group (2.9%) and one in the RALP group (0.5%) required transfusion of blood products (P = 0.14). Conclusions. The results of this study have shown that RALP is associated with less intraoperative bleeding than RRP, and patients undergoing RALP have a greater serum hematocrit at hospital discharge. The lack of a statistically significant difference in blood transfusion was partially attributable to the low transfusion rate in both groups in this series.