The "daVinci" Robotic device is a marvel of technological achievement. Our physicians have been using robotics for over a year at Lawrence Memorial Hospital to perform a variety of urologic procedures, including partial kidney removal, pyeloplasty, kidney and ureter surgery, bladder surgery, and sacrocolpopexy. For these procedures, we have found the daVinci robot to be a great tool for high levels of surgical precision and for reduction in post-operative pain and hospital stay for our patients.
However, when it comes to the treatment of prostate cancer, we maintain our stance that the standard "radical prostatectomy" surgery is as good as, and in many cases better than, robotic prostatectomy. For several years now, there has been very aggressive advertising directed toward patients, urologists, and primary care physicians regarding robotic surgery for prostate cancer. This advertising included numerous unsubstantiated claims regarding the "many advantages" of robotic surgery over traditional retropubic surgery. We remained very skeptical of these claims, as they were unproven and we felt that this phenomenon was driven by marketing rather than science. Nevertheless, we have continued to monitor the literature and our own patient experiences to make a judgment about whether to pursue robotic surgery at Lawrence Memorial Hospital.
Over the last several years, mature data are being published and our skepticism has been vindicated. As Dr. William Catalona, professor of urology at Northwestern University, states in referring to a New York Times article published in August 2008, "The marketing and hype of robotic prostatectomy have not fooled all the people all the time.1, 2
According to multiple studies 3-12, there is no apparent benefit to robotic surgery over retropubic surgery in terms of:
- cancer control, surgical margins, or disease-free survival
- pain scores, hospital stay, infection rates, or recovery time
- incidence of side effects such as incontinence or erectile dysfunction
Furthermore, robotic prostatectomy has the following disadvantages:
- much longer OR times, resulting in OR inefficiency and increased cost
- violating the peritoneal cavity, with risk of bowel injury, adhesions and ileus – (in contrast to retropubic surgery which does not enter this cavity)
- huge increase in costs, with capital outlay as well as maintenance contracts
- several studies show a slightly higher risk of complications with robotic surgery
There are urologic procedures for which the robotic method certainly does make sense due to its advantages, and we are performing these at LMH. However, the prostatectomy is not one of those. We believe patients should have the right to make any decision they are comfortable with – as long as they have accurate information.
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- Catalona W. Is robotic radical prostatectomy ready for prime time? AUA News 2009; July: vol 14 (7): 20-22
- Parker-Pope T: Regrets after prostate surgery. In: Well: Tara Parker-Pope on Health. The New York Times, August 27, 2008.
- Ghavamian R: The urologic oncologist, robotic, and open prostatectomy: the need to look through the hype and propaganda and serve our patients. Urol Oncol. 2009; May-Jun; 27 (3): 233-5
- Nosnik IP, Gan TJ, Moul JW: Open radical retropubic prostatectomy 2007: the true minimally invasive surgery for localized prostate cancer. Expert Rev Anticancer Ter. 2007; Sep;7(9):1309-17
- Lepor H: Status of radical prostatectomy in 2009: is there medical evidence to justify the robotic approach? Rev Urol. 2009; Spring; 11(2):61-70
- Eastham JA: Robotic-assisted prostatectomy: is there truth in advertising? Eur Urol 2008; 54: 720.
- Hu JC, Wang Q, Pashos CL et al: Utilization and outcomes of minimally invasive radical prostatectomy. J Clin Oncol 2008; 26:2278.
- Touijer K, Eastham JA, Secin FP et al: Comprehensive prospective comparative analysis of outcomes between open and laparoscopic radical prostatectomy conducted in 2003 to 2005. J Urol 2008; 179: 1811.
- Schroeck FR, Krupski TL, Sun L et al: Satisfaction and regret after open retropubic or robot-assisted laparoscopic radical prostatectomy. Eur Urol 2008; 54: 785.
- Nelson B, Kaufman M, Broughton G et al: Comparison of length of hospital stay between radical retropubic prostatectomy and robotic assisted laparoscopic prostatectomy. J Urol 2007; 177: 929.
- Wood DP, Schulte R, Dunn RL et al: Short-term health outcome differences between robotic and conventional radical prostatectomy. Urology 2007; 70: 945.
- Dahl DM, Barry MJ, McGovern Y et al: Prospective study of symptom distress and return to baseline function after open versus laparoscopic radical prostatectomy. J Urol 2009; 182:956