Robotic prostatectomy: Is it fulfilling expectations?
With rising health care costs and the increasing expense of the robotic platform, many believe that robotic prostatectomy must prove superior to its open counterpart in some way other than convalescence alone.
Notably, the 2007 European Association of Urology annual congress offered two important, yet different papers demonstrating signs of progress in the robotic prostatectomy. Van Migem and associates reported a single-center, retrospective experience relating nuances of the surgical dissection to subsequent margin positivity and continence (see, "Robotic RP shows good oncologic, functional outcomes"). More specifically, they attained an overall positive margin rate of 15% and a continence rate of 95%. Erectile function had favorable results, as well, although potency measures are generally more qualitative.
While it is important to highlight the technical caveats outlined by Van Migem, such as a complete periurethral dissection, the strength of this study is in its demonstrated patient benefits of improved margin status, continence, and erectile function. Regardless, while this series is impressive, further validation will take place as more and more centers report favorable results.
At this time, we are reaching an important stage in the ongoing development of robotic prostatectomy. The emerging studies feature different initiatives targeting the same goal: an effective and reproducible minimally invasive alternative to open prostatectomy. Not surprisingly, most of the available evidence supports that robotics in urology is here to stay, although long-term studies are still pending. Regardless, most practicing urologists believe the time has come for all centers to evaluate offering robotics for their patients requiring prostatectomy.
Dr. Nakada, a Urology Times editorial consultant, is professor and chairman of urology at the University of Wisconsin, Madison.
