Here’s a review study on robotic-assisted versus the traditional open prostatectomy. And, the conclusion is that the robotic-assisted procedure provides outcomes at least as good if not better than the open prostatectomy.
Robotic-assisted laparoscopic prostatectomy: do minimally invasive approaches offer significant advantages?
Smith JA JR, Herrell SD.
J Clin Oncol. 2005 Nov 10;23(32):8170-5. Review
Vanderbilt University Medical Center, Department of Urologic Surgery, A 1302 Medical Center N, Nashville, TN 37232-2765, USA. joseph.smith@vanderbilt.edu
Radical prostatectomy has maintained a cardinal role in the treatment of localized prostate cancer. Robotic-assisted laparoscopic prostatectomy (RALP) has been introduced as a less invasive surgical approach. Available data on RALP versus open approaches were reviewed for surgical and cancer related outcomes. RALP is consistently associated with decreased blood loss and limited postoperative pain and hospital stay. Surgical margins seem similar between most reported series of RALP or open radical prostatectomy. Most intrainstitutional comparisons demonstrate better postoperative continence and potency with RALP, but there is still debate about whether results are superior to radical retropubic prostatectomy in the hands of a highly experienced surgeon. RALP provides outcomes at least comparable, and, in some measures, superior to open surgery. Refinements of instrumentation may provide even better results in the future.
Here’s another study directly comparing robotic-assisted versus the conventional and laparoscopic procedures.
And the conclusions again are that the operating time, and more significantly the side effect profile (median time to urinary incontinence and resumption of sexual activity), were less with the robotic procedure.
Laparoscopic radical prostatectomy: conventional and robotic.
Menon M, Shrivastava A, Tewari A.
Urology. 2005 Nov;66(5 Suppl):101-4. Review
Vattikuti Urology Institute, The
Josephine Ford Cancer Center, Henry Ford Health System, Detroit, Michigan 48202, USA. scomisk1@hfhs.org
By 2015, prostate cancer will become the most commonly diagnosed cancer in men. Radical prostatectomy reduces disease-specific mortality in patients with localized prostate cancer; however, the invasiveness of surgery and its resultant side effects cause many men to seek other treatments. In 2000, laparoscopic radical prostatectomy emerged as a minimally invasive alternative to open surgery; it has been refined recently by the addition of robotic technology. To examine the outcomes of robotic radical prostatectomy and compare them with those from open and conventional laparoscopic radical prostatectomy, we prospectively collected baseline demographic data on all patients undergoing surgery for prostate cancer over a 4-year period at our center. Urinary function and sexual function were evaluated using standardized criteria as well as a questionnaire preoperatively and at 1, 3, 6, 12, and 18 months after their procedure. Operative and postoperative outcomes were compared using values for open radical prostatectomy as the reference standard. A total of 100 men underwent open radical prostatectomy with conventional laparoscopic radical prostatectomy (n = 50) and robotic radical prostatectomy (n = 500). The odds ratios for operative times, blood loss, postoperative pain, complications, and median times to urinary continence and resumption of sexual activity all were lower for robotic than for open or laparoscopic radical prostatectomy. It appears safe to conclude that conventional laparoscopic radical prostatectomy is a reasonable alternative to open radical prostatectomy in the surgical treatment of patients with clinically localized prostate cancer. The incorporation of robotics may result in even better surgical outcomes than conventional laparoscopy. However, the surgical robot is expensive; few centers have access to the technology and even fewer have expertise in the technique. For robotic radical prostatectomy to become the standard of care for the treatment of localized prostate cancer will require economies of cost, dissemination of surgical expertise, and data from randomized trials.
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