Robot-Assisted Prostatectomy: Beyond the Flashy Technology
Just how good is robot-assisted radical prostatectomy? Many centers, in aggressive marketing campaigns, proclaim the miracles of the robotic procedure — its minimal invasiveness, its short recovery time, its delicacy and accuracy. At the Brady, Hopkins urologists have been performing minimally invasive radical prostatectomies for several years — first, using the conventional laparoscopic technique, and more recently, using the daVinci Surgical System, a highly sophisticated, four-armed robotic device that allows the prostate to be removed through six keyhole-sized incisions. But this team of surgeons has also been looking past the flashy technology, working hard to evaluate these procedures — subjecting them to rigorous standards, to determine the true impact on cancer cure, urinary continence, preservation of sexual function, and even cost-effectiveness.
“Along with enthusiasm for a new technology comes the responsibility of comparing its success to that of the ‘gold standard’ — the open surgical procedure,” says Li- Ming Su, M.D., Director of Laparoscopic and Robotic Urologic Surgery. There are no long-term results yet, because the technology is too new. But the Brady team is working on it, “collecting and studying data on cancer margins and the rate of recurrence, as well as continence and potency with validated quality-of-life surveys.”
“We established our program for robotassisted laparoscopic radical prostatectomy in 2005,” says Su, “with more than 375 cases performed so far.” But that number is increasing rapidly: “In just two years, we have seen a six-fold increase in the number of cases, and for the year 2007, our department is on track to perform over 300 robotassisted laparoscopic radical prostatectomies” — about one-third of all prostatectomies performed at Hopkins. With the daVinci System, the surgeon operates from a computer console, looking at a three-dimensional image with 10X magnification. “With one of the robotic arms controlling the endoscope, the surgeon actively works with the remaining three robotic arms — each one equipped at the end with sophisticated, multi-jointed instrument tips that allow us to operate and dissect fine tissues with the dexterity of a human wrist.”
There are no long-term results yet,
Currently, Su and five other Brady surgeons — Jonathan Jarow, Mark Gonzalgo, Christian Pavlovich, Mohamad Allaf, and Misop Han — offer this technique routinely to patients with organ-confined prostate cancer. There is also a specially trained team of operating room nurses, physician assistants, and anesthesiologists. The short-term results are excellent. “For the patient, blood loss and transfusion rates are minimal, average hospital stays are one to two days, and the urethral catheters are removed in most patients by one week following surgery,” notes Su. He is optimistic that the longterm results will be just as promising.