Success of Radical Prostatectomy - Be It Open or Robotic Depends on Experience of Surgeon

Robotic-assisted prostatectomy and open retropubic prostatectomy for treating prostate cancer appear to have similar results if done by an experienced surgeon.

Robotic surgery or robot-assisted radical prostatectomy is being increasingly used for surgery of prostate cancer and is slowly replacing open surgical procedures.
Comparison was made about surgical outcomes following robotic surgery and open retropubic prostatectomy.
Early studies indicate that an experienced surgeon is the key factor in the successful outcome of the surgery be it open or robotic surgery.

Is a robot a better surgeon than a human when it comes to treating prostate cancer with surgery? Some may feel newer technology is more accurate. Others may say that nothing can beat traditional approaches in Medicine. The early results of a study that attempts to answer this question were published in The Lancet.

Prostate surgery has seen several advances in recent times. Radical prostatectomy is a common procedure where the prostate is removed along with its neighboring tissues. Depending on the site of the incision, the surgery may be radical retropubic prostatectomy, where the incision is made in the lower abdomen, or radical perineal prostatectomy, where the incision is made in the perineal region. Transurethral resection of prostate (TURP) is also sometimes done to relieve urinary symptoms. In this procedure, the prostate is cut through an instrument that is introduced into the urethra. It is more commonly done for benign prostate hyperplasia (BPH).

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‘The human touch seems to be as important as robots when it comes to surgery for prostate cancer.’

In contrast to open surgery, laparoscopic or keyhole surgery requires more surgical skill and experience. The recovery time is however faster with this type of surgery. The robotic da Vinci system is an advancement in the field of laparoscopic surgery. It must be clarified that a robotic surgery does not mean that a robot does the surgery all by itself. The surgeon guides the robotic arms in such a way that the surgery can be carried out with precision. Such a surgery is more appropriately called robot-assisted surgery.

Research team compared the surgical results and outcomes of robotic radical prostatectomy versus open radical retropubic prostatectomy.

The patients included in the study were men of 35 to 70 years of age, had localized prostate cancer and an estimated life expectancy of 10 years or more. In the study 157 patients underwent laparoscopic robotic radical prostatectomy while 151 underwent open radical retropubic prostatectomy.

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Side effects of prostate surgery include urinary incontinence and sexual dysfunction. Based on a questionnaire taken from 121 patients who underwent open surgery and 131 patients who underwent robotic surgery, it was found that the urinary function was similar in the two groups, at 6 weeks or 12 weeks after surgery.

The effects of the two surgeries on sexual functions were also not significantly different.

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Complications during and after the operation were slightly higher in the open radical prostatectomy group as compared to the robotic surgery group. Intraoperative complications occurred in 9% and 4% in the radical retropubic prostatectomy group and the robot-assisted laparoscopic prostatectomy group, while postoperative complications were noted in the 8% and 2% patients, respectively.

Further data which will be obtained after 24 months after the surgeries will provide further insight into the possible difference or lack of difference between the two procedures.

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The study concluded that when choosing this operation, it is more important for the patients to get the surgery done from an experienced surgeon rather than worrying about the type of technique used to remove the cancerous prostate gland. Laparoscopic robotic surgery in this study did not show any advantage over open prostatectomy when an experienced surgeon was performing the surgery.

References:

Yaxley JW et al. Robot-assisted laparoscopic prostatectomy versus open radical retropubic prostatectomy: early outcomes from a randomised controlled phase 3 study. The Lancet. DOI: http://dx.doi.org/10.1016/S0140-6736(16)30592-X

Source-Medindia