Advantages of Robotic Prostatectomy
Robotic Prostatectomy
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I think robot assisted surgery has a number of advantages.
Although there’s been no randomised controlled trial comparing open and robot assisted surgery and there’s unlikely to be I do feel that robotic surgery offers significant advantages.
It offers excellent cure rates.1
There is improved preservation of nerves for erectile function2 and excellent short and long term continence results3.
Patients have a reduced hospital stay and importantly return to work much quicker than with open surgery4.
There’s a very low complication rate with a low minor and major complication rate and a decreased blood loss5.
Fortunately in my 2000 cases I’ve had a zero blood transfusion rate because of the excellent anastomosis or join that we get we have a very, very low stricture rate, that is scarring at the join between the bladder and the urethra.
Patients have very little pain and a very low infection rate6 because they’re only a small incision inside the abdomen and not open throughout the procedure.
Over 95% of patients have their catheter out on day five or day six7 and I think that’s another very positive thing.
I personally feel that a very good robotic procedure is probably better than a very good open procedure but it’s really important for patients to find out what the outcomes of their particular surgeon is and choose what’s best for them.
For example a poor robotic procedure would be worse than a very good open procedure.
So I think it’s imperative for patients to really find out the clinically outcomes of the surgeons they’re seeing and it allows them to make an informed decision on what’s best for them.
References
1. Ugo Giovanni Falagario, Sophie Knipper, Francesco Pellegrino, et al - Prostate Cancer–specific and All-cause Mortality After Robot-assisted Radical Prostatectomy: 20 Years’ Report from the European Association of Urology Robotic Urology Section Scientific Working Group - https://doi.org/10.1016/j.euo.2023.08.0052. Nobuhiro Haga, Takeshi Miyazaki, Kazuna Tsubouchi - Comprehensive approach for preserving cavernous nerves and erectile function after radical prostatectomy in the era of robotic surgery - Int J Urol . 2021 Apr;28(4):360-368. doi: 10.1111/iju.14491. Epub 2021 Jan 28.
3. Francesco Sessa, Rossella Nicoletti, Alessio Pecoraro, et al - Urinary Continence Recovery after Robotic Radical Prostatectomy without Anterior or Posterior Reconstruction: Experience from a Tertiary Referral Center - J Clin Med. 2023 Feb; 12(4): 1358. Published online 2023 Feb 8. doi: 10.3390/jcm12041358
4. Eliney Ferreira Faria, Roberto Dias Machado, Rodrigo José Costa Gualberto - Patient’s safety and satisfaction on same day discharge after robotic and laparoscopic radical prostatectomy versus discharge after 24 or 48 h: a longitudinal randomized prospective study - BMC Urol. 2023; 23: 149. Published online 2023 Sep 21. doi: 10.1186/s12894-023-01318-2
5. Tomás Bernardo Costa Moretti, Luís Alberto Magna and Leonardo Oliveira Reisa - Surgical Results and Complications for Open, Laparoscopic, and Robot-assisted Radical Prostatectomy: A Reverse Systematic Review - Eur Urol Open Sci. 2022 Oct; 44: 150–161. Published online 2022 Sep 8. doi: 10.1016/j.euros.2022.08.015
6. Wei Zhu, Lingfeng Wu, Wenhua Xie - Wound infection in robotic‐assisted radical prostatectomy compared with retropubic radical prostate surgery: A meta‐analysis - Int Wound J. 2023 Nov; 20(9): 3550–3557. Published online 2023 Sep 7. doi: 10.1111/iwj.14228
7. Sebastian Lenart, Ingrid Berger, Judith Böhler - Ideal timing of indwelling catheter removal after robot-assisted radical prostatectomy with a running barbed suture technique: a prospective analysis of 425 consecutive patients - World J Urol. 2020; 38(9): 2177–2183. Published online 2019 Nov 14. doi: 10.1007/s00345-019-03001-4