Which is better for prostate surgery – open surgery or robotic?

CONS OF USING ROBOTIC SURGERY

This doctor does not recommend robotic surgery http://www.drcatalona.com/qa/faq_initial-treatment.asp

Reasons: “it is far more difficult to get consistently good results because it does not afford the surgeon as much control as with the traditional operation. Also, it does not provide tactile feedback, and it is more difficult to suture laparoscopically.  The surgeon cannot tell how hard the robot is grasping tissue, or, if the angle of the needle is wrong and if the needle does not pass through the tissues easily, the robot continues to “muscle” its way through. With tactile feedback afforded by open surgery, the surgeon would “feel” the mistake and make the necessary adjustment.

Having seen laparoscopic and robotic surgery performed by most of the world’s most experienced experts, I don’t believe it allows nerve-sparing to be performed with the same degree of fine control without risking thermal damage to the neurovascular bundles, and I do not believe removal of the cancer is as consistently complete.

STUDY

the most significant outcomes (cure, continence, and potency) are no better with LRP or RALRP than with conventional ORP. Therefore, in experienced hands, ORP remains the gold standard procedure [ Open Versus Laparoscopic Versus Robot-Assisted Laparoscopic Prostatectomy: The European and US  experience – Julia Finkelstein, BSc, Elisabeth Eckersberger, MPA, Helen Sadri, MD, Samir S Taneja, MD, Herbert Lepor, MD, and Bob Djavan, MD, PhD]

STUDY IN AUSTRALIA – no real difference in outcomes

Expensive robotic prostate surgery, marketed as “ground breaking”, “revolutionary” and “nerve sparing”, has been found to be no better at preserving men’s urinary continence and sexual function than traditional surgery. A landmark Australian study made the finding after comparing the advanced surgery, which can cost more than $10,000, with traditional open surgery three months post operation.  Patients who had the open surgery lost more blood during the procedure but none of them needed transfusions. Patients who had open surgery had a longer hospital stay post surgery and experienced more pain doing day to day activities one week after the operation but, on average, both groups spent the same number of days off work.

President of the Urological Society of Australia and New Zealand Mark Frydenberg said the study, published in The Lancet medical journal on Wednesday, showed both techniques were “equally effective”.

Professor Frydenberg said “patients without access to robotic surgery should not feel in any way disadvantaged or be concerned they will have an inferior outcome”.

“Our view is that both robotic and open surgery are very valid treatments for prostate cancer but what is of most relevance to outcomes is the skill and experience of the surgeon,” he said.

[Source]

MY CONCLUSION

Robotic is new and potentially OK, but because there is no longer term difference in outcomes, I think open is OK. At least at this stage, when surgeons trained in open surgery are still available. In the future such surgeons may become fewer and fewer.

ADDENDUM

But there is a major issue that has low probability of occurring but can cause real problems. Scar tissue can be formed due to poor healing, causing enormous problems.

http://urology.jhu.edu/newsletter/prostate_cancer825.php

Worse thing is that the problem returns every three months once it starts:
Apparently, this is less of a problem with robotic surgery since it can apply a running suture (12 stitches). The manual surgery (open) is only able to apply seven, and not very well.
It has a few other advantages as well: “Cutting and putting in stitches is easier with the robotic assistance” (Source), recovery is quicker, etc.
As a result I’ve gone for robotic.

Comparison of Prostatectomy Surgical Options: Open, Laparoscopic, and Robot-Assisted Laparoscopic

  Open Surgery* Robot-Assisted Laparoscopic*

 

Surgery Time 3 1/2 Hours 3 1/2 Hours
Hospital Stay 2 Days 1 Day
Total Incision Length 5 inches 2 inches
Estimated Blood Loss 375 cc 116 cc
Visualization 3 D 3 D
Magnification of Visualization up to 3X with magnifying glasses 10-12 X (utilizing a pair of high resolution cameras)

 

Instrument Handling Normal Normal (Optional Micro-precision)

sabhlok

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