Robotic RP shows improved short-, intermediate-term outcomes

May 16, 2011

Despite the absence of long-term outcomes, the use of robots in radical prostatectomy is growing exponentially and producing very acceptable short- and intermediate-term outcomes.

Despite the absence of long-term outcomes, the use of robots in radical prostatectomy is growing exponentially and producing very acceptable short- and intermediate-term outcomes.

The robotic procedure shows overall lower perioperative morbidity and improved oncologic outcomes versus conventional laparoscopic or open approaches, according to a study by presented by Prasanna Sooriakumaran, MD, PhD, of Weill Cornell Medical College, New York.

"The perceived advantage is that it has a much shorter learning curve," Dr. Sooriakumaran told Urology Times. "It is easier to learn and get good outcomes. This is why use of the robot has taken off. It has long been known that open prostatectomy has more blood loss and longer recovery. These are not associated with laparoscopy, but laparoscopy has a long learning curve and not everyone can master it."

Dr. Sooriakumaran, working with Ashutosh Tewari, MD, and colleagues, undertook a massive meta-analysis of 251 published studies. The studies encompass 65,552 open, 23,687 laparoscopic, and 20,777 robotic procedures.

Dr. Sooriakumaran observed that a surgeon could become acceptably proficient at conducting robot-assisted prostatectomy after as few as 50 or more procedures, whereas attaining proficiency in open or laparoscopic surgeries might require completion of several hundred procedures.

Dr. Sooriakumaran explained the impetus for the analysis, saying, "The robot is the newest kid on the block. It has been around only since the beginning of this millennium, but its popularity has increased exponentially in the last 5 or so years. We can’t really say what the 10-year outcomes are because it hasn’t been around that long."

The Cornell researchers concluded that robot-assisted laparoscopic prostatectomy is associated with low perioperative morbidity and improved oncologic outcomes compared with other invasive procedures. Cost was not addressed by the study, but Dr. Sooriakumaran noted that cost could be an important issue.