Robotic radical prostatectomy has exciting future, studies suggest

In the first article, Lee et al from the University of Pennsylvania found that the surgeon's perceptions of the quality of key steps during robot-assisted prostatectomy do not correlate with early return of urinary continence (see article, page 1). As surgeons, we would like to think we can tell when we do a good job and when we do a less-than-optimal job. Certainly, this is the case in broad terms, but this research suggests that for a surgeon operating at the highest level of technical expertise (Dr. Lee reports an experience of more than 2,000 procedures), the small, perceived variations in performance are probably less important than the anatomy and functionality of the patient.

In a way, this work highlights one of the advantages of the robotic approach to radical prostatectomy; once expertise is gained, the surgeon's consistency likely is quite high. The improved ergonomics of the robotic platform, compared to that of standard laparoscopic or open surgical prostatectomy, also likely extends the career of a prostate surgeon so that more patients can benefit from the surgeon's consistent expertise.

This work illuminates what might be the ultimate benefit of the robotic platform; it might allow not only more consistent and more comfortable performance of the surgery as currently performed, but more importantly, might improve outcomes by allowing modifications of surgical procedures that would not be possible with hand-held laparoscopic or open surgical instruments.

Although we are still waiting for definitive evidence that robotic assistance improves radical prostatectomy, findings such as those reported here suggest an exciting future for the technology.

Dr. Wolf, a member of the Urology Times Editorial Council, is professor of urology at the University of Michigan, Ann Arbor.