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Ann Arbor, MI--Urologic oncologists adept in performing open radical prostatectomy should feel comfortable undertaking robotic-assisted laparoscopic prostatectomy without worrying about encountering a significant learning curve. However, for the laparoscopic surgeon, the robot seems to offer little benefit for facilitating laparoscopic surgery, according to findings of a small prospective study from the University of Michigan, Ann Arbor.
The findings are based on an evaluation of pathologic and surgical outcomes from patients who underwent open, laparoscopic, or robotic-assisted prostatectomy using the daVinci Surgical System (Intuitive Surgical, Sunnyvale, CA) performed by two attending surgeons. David P. Wood, MD, is professor of urology, University of Michigan, Ann Arbor, specializing in urologic oncology and having no laparoscopic training. His laparoscopically trained colleague J. Stuart Wolf, Jr, MD, is director of the Michigan Center for Minimally Invasive Urology, and had no recent experience performing radical prostatectomy.
In his robotic cases, a laparoscopic fellow or senior resident assisted Dr. Wood, while Dr. Wolf received assistance from an attending oncologist or senior resident. The surgical groups were not significantly different with respect to biopsy Gleason score, patient age, or prostate volume.
However, for the next 20 procedures performed by Dr. Wood, the average length of stay fell to 1.1 days, while mean operative time and estimated blood loss were relatively unchanged at 235 minutes and 140 mL, respectively.
Comparison of outcomes achieved in Dr. Wolf's first 10 robot-assisted procedures and his first 10 laparoscopic prostatectomies showed the robot-assisted procedure was associated with a reduction in average operative time of approximately 40 minutes and decreased estimated blood loss of approximately 65 mL. However, the differences between the procedures in those outcomes were not statistically significant.
Dr. Wood suggested two reasons that may account for the results. First, the urologic oncologist, skilled in performing open radical prostatectomy, has the advantage of familiarity with the relevant anatomy and surgical technique. By contrast, a laparoscopist has expertise in renal stone management and other non-oncologic endoscopic procedures, but not prostatectomy.
Second, while laparoscopic radical prostatectomy is a challenging procedure with a steep learning curve, the daVinci robot provides a useful tool for the urologic oncologist. On the other hand, the trained laparoscopist has nothing to gain from the robot.
"Robot-assisted prostatectomy truly assimilates the open technique and allows the surgeon who knows how to do open radical prostatectomy to transfer those skills successfully without facing much of a learning curve," Dr. Wood told Urology Times. "On the other hand, a surgeon who is already skilled in laparoscopy doesn't benefit from a crutch, but simply needs more experience with prostatectomy to become familiar with the operation."