Robotic-Assisted Prostate Surgery Outcomes Improve with Practice

A new study shows that robot-assisted radical prostatectomy (RARP) in the hands of skilled surgeons result in a shorter average hospital stay and lower overall complication rate.

Researchers at the MD Anderson Cancer Center (Houston, TX, USA) conducted a large, population-based study to assess the learning curve effect of RARP, and to compare the results to open radical prostatectomy (ORP) in the same settings. The patient population for the study was from the Premier Perspective database, and consisted of 71,312 procedures performed at 300 hospitals by 3,739 surgeons between 2004 and 2010; pretreatment comorbidity profiles were similar in all cohorts. The key endpoints were surgery time, inpatient length of stay, and overall complications.

The results showed that mean surgery time was longer for RARP (4.4 hours) compared to ORP (3.4 hours) in the same hospitals, but inpatient stay was shorter for RARP (2.2 days) compared to ORP (3.2 days). The overall complication rate for RARP (10.6%) was less than that for ORP (15.8%), as were transfusion rates. ORP results in hospitals without a robot were not better than ORP with a robot. Trending of results by year of procedure showed no differences in the three cohorts, but trending of RARP results by surgeon experience showed improvements in surgery time, hospital stay, conversion rates, and complication rates. The study was published in the December 18, 2013, electronic edition of the Journal of Endourology.

“During the initial seven years of RARP development, outcomes showed decreased hospital stay, complications, and transfusion rates. Learning curve trends for RARP were evident for these endpoints when grouped by surgeon experience, but not by year of surgery,” concluded lead author John W. Davis, MD, and colleagues. “Our analysis shows that outcomes of robotic-assisted radical prostatectomy improve as surgeons gain more experience with the procedure, and generally can be favorable relative to open surgery.”

The goal of radical prostatectomy is to excise the cancer completely, provide good urinary continence postoperatively, and maintain the ability to have erections after the surgery (if present before the surgery). RARP is performed with the assistance of a surgical robot, which duplicates the standard retropubic ORP, but with smaller incisions. Through these incisions are passed a camera, two robotic manipulating arms, and two assisting instruments. The surgeon sits at a console and manipulates the robot arms and camera with hand-controls, while looking at the operative field with an immersive 3-dimensional (3D) view. The advantages of RARP include improved cosmetic result, less blood loss, and briefer and less intense postoperative convalescence.

Related Links:
MD Anderson Cancer Center