Robot-assisted trend continues to grow

Amsterdam, Netherlands-Open radical prostatectomy remains the standard surgical approach for the management of localized prostate adenocarcinoma, but recent data show that this may be changing. As robot-assisted surgery becomes more prevalent in the urologic community, practice patterns appear to be shifting from open radical prostatectomy toward robot-assisted laparoscopic radical prostatectomy.

"More than 95% of radical prostatectomies this year will be performed robotically at Hackensack University Medical Center by two academic and seven community urologists," said Ravi Munver, MD, chief of minimally invasive urologic surgery and director of the endourology fellowship program at the center.

At the World Congress on Endourology, Dr. Munver and associates reported retrospective 5-year data on the radical prostatectomy practice patterns at their institution between January 2000 and April 2005.

Shift over 5 years

As more surgeons became trained in robot-assisted surgery, the trend gradually shifted toward the robotic approach. The percentage of open prostatectomies decreased over time, while the percentage of robot-assisted procedures gradually increased. Specifically, all radical prostatectomies in 2000 were performed through the open approach at the institution.

Currently, more than 95% of radical prostatectomies are performed with robotic assistance. Furthermore, the total number of prostatectomies performed has steadily increased between 2000 and 2005.

"The robotic surgical system allows surgeons to overcome the challenges of conventional laparoscopy and has made minimally invasive radical prostatectomy a more widely available alternative to open surgery," Dr. Munver said.

Robotic technology allows experienced surgeons to transfer open surgical skills to the laparoscopic setting and offers patients benefits of decreased postoperative pain, decreased intraoperative blood loss, decreased catheter time, shorter hospital stay, and more rapid convalescence, he said. Most patients require only oral narcotics for pain control after the robotic procedures, whereas IV analgesia is often required following open surgery. In addition, blood loss decreased to an average of 109 cc with the robotic approach versus 425 cc with the open approach in Dr. Munver's series.

Certainly, robot-assisted prostatectomy appears to be riding a wave of popularity at the moment. Both technology and marketing have played significant roles in driving this trend, Inderbir Gill, MD, head of the section of laparoscopic and minimally invasive surgery at the Cleveland Clinic Glickman Urological Institute, said in a lecture at the World Congress. In addition, encouraging oncologic data from the various published robotic series appear to be diminishing the number of radical prostatectomies performed using the gold-standard open approach.