Is an Open Radical Prostatectomy Inferior or Superior to Robotic Surgery?

[JoelT]

In a randomized, multi-center phase III trial comparing the clinical outcomes of robot-assisted v open laparoscopic radical prostatectomy in 326 men with newly diagnosed early-stage prostate cancer there was no difference in the eventual clinical outcomes.

The researchers found that the urinary and sexual functions of men in both groups were similar at 12 weeks post surgery. They also found that the positive surgical margin rates were not significantly different between the two groups.

The researchers concluded that the robot-assisted laparoscopic radical prostatectomy has similar clinical outcomes to those achieved with an open radical prostatectomy.

Citation- Robot-Assisted Laparoscopic Prostatectomy Versus Open Radical Retropubic Prostatectomy: Early Outcomes From a Randomised Controlled Phase 3 Study; Lancet 2016 Jul 26;[EPub Ahead of Print], JW Yaxley, GD Coughlin, SK Chambers, S Occhipinti, H Samaratunga, L Zajdlewicz, N Dunglison, R Carter, S Williams, DJ Payton, J Perry-Keene, MF Lavin, RA Gardiner

Joel

[GeoffNoLongerAS]

The study makes sense to me. I view the robot as a tool only as good as the surgeon who wields it. I would like to see if the study controlled for the experience of the surgeon.

Though surgeons don't like to study themselves, I have seen a couple of studies, one presented by urological surgeon, that measured the number of surgeies vs biological reoccurnce. The resultant graph was enlightening. It showed a sgnificant and dramatic drop as the sugeries increased until around 250 -300 surgeries, then leveled off with a slow decline.

I spoke with a surgeon that had done quite a few surgeries both open and RP. I asked him if he had ever had the robot fail during surgery. He did once and had to proceed RP. There is at least one case in which the patient died after the robot cut an artery. Undetermined is whether it was the robot malfunctioning or the inexperience of the surgeon possibly magnified by the robot.

None of this is to say a robot should not be used. It seems to me that being enamored with technology and looking for a surgeon that does robotic surgery is the wrong approach. If and when I need surgery, I am on AS, I will look for a surgeon with experience and let him/her choose the method.

After all, when you look for someone to work on your house you ask about experience and results, not what power tools they use. Surgery on your body shouldn,t be any different.

[JoelT in reply to GeoffNoLongerAS]

We always have to remember that the robot is a tool under the direct control of the surgeon. The robot does not do the surgery it's still the surgeon who does the surgery.

There is a lot of excellent research that clearly shows the more experienced a surgeon the better the outcomes. This is true whether or not it's an open surgery, laparoscopic or robotic surgery.

Joel

[Dr_WHO in reply to JoelT]

Open or robotic, the results are similar. It comes down two experience of the surgeon and personal performance. In my case, I was lucky enough to have the surgeon that pioneered the robotic technique back in 2001 and has done thousands of operation. I also like the fact that it has faster recovery and less chances of infection. My brother has an urologist from Mayo Clinic. He favors open over robotic.

[speedyhaddock]

In Dec 2006 I had a radical Prostatectomy which left me with a row of staples closing the operation site from navel to just above the pubic area . in hospital for ten days. A friend has in the last 18 months had the same procedure performed robotically leaving him with 7 small incisions so a much less invasive technique added patent recovery . Both operations have been successful in that both of our PSA checks are in the 0000.1 range So as far as I am concerned if your consultant recommends robotic surgery go for it, the overall results should be exactly the same. Just remind your self that you are a unique being, & as we are all slightly different results can vary We are not machine's that you can replace the carburetor's or brake discs as a bolt on task . The Doctors do know what they are doing and are working just for you and will sort your ailment out. PS I was going to post a photo of my operation site but it doesnt let me post pictures