Expert Discusses Using Robotic Surgery for Prostate Cancer
For patients with prostate cancer who are undergoing a prostatectomy, robotic surgery has had a huge impact.
Compared with open surgery, “the recovery time is much quicker than open surgery,” said David Albala, M.D., in an interview with CURE. “It is a minimally invasive procedure so there is less pain and less blood loss.”
Robot-assisted radical prostatectomies increased from 13.6 percent in 2003 to 2004 to 72.6 percent in 2011 to 2012. This procedure has comparable cancer control and improved overall survival (OS) versus open surgery. Robotic surgery has also been associated with less use of additional treatment compared with open radical prostatectomy.
Albala, medical director, co-director of Research at Associated Medical Professionals and chief of Urology at Crouse Hospital, discusses the uses and benefits of robotic urological surgery in prostate cancer, as well as methods to achieve better physician compliance.
Can you explain the benefits of robotic urological surgery?
Robotic surgery has a firm implant in urological surgery, especially oncology with prostatectomy, partial nephrectomy, and cystectomy work. The real benefit of robotic surgery is that patients can leave the hospital.
Now, an experienced robotic surgeon can do these procedures in a timely fashion. Obviously, there is a learning curve that is associated with robotics, but most of us have passed that learning curve. We now have done 1,000 to 3,000 prostatectomies. The learning curve has passed. The time of surgery is equivalent to open surgery and the efficacy of the procedure, complication rates, impotence and incontinence are the types of complications that are very comparable to what we see with open surgery.
The patient benefits because the recovery time is much quicker. They are out of the hospital typically in one day and a catheter is left in place for approximately one week, which is somewhat shorter than what we saw with open surgery. In partial nephrectomies for kidney tumors, patients in my practice typically stay in the hospital overnight and are able to leave the next day. Many of the same benefits that we see with prostatectomy can be translated in partial nephrectomy and cystectomy.
Are there certain patients who are better for robotic surgery than others?
All patients who are surgical candidates for the procedure that they're going to have can be done robotically. If a patient is a candidate for a prostatectomy — whether you do it with a retropubic, perineal, or a robotic approach — all of those patients can be operated on robotically.
Obese patients can be done robotically with the new da Vinci system. These have longer reaches for their instruments, and these procedures can be done with greater ease. Those were difficult with some of the earlier types of the prototypes of the robot but, as the evolution of the robots has taken place, we can now perform this procedure on obese patients much better and get better results. Anything that we can do with an open procedure we can do robotically.
What impact has robotic surgery had in prostate cancer?
The real benefit has been the shorter recovery time. There is good documentation in the literature about blood loss. The average blood loss for a robotic prostatectomy is about 150 cubic centimeters, which is just a small amount compared with an open prostatectomy, which is 700 to 1,000 cubic centimeters. There is quite a difference.
Clearly, the hospitalization time is shorter robotically, although lines get blurred. If you're a very experienced open surgeon, you can have tremendous outcomes, which are very comparable to what we see robotically.
The efficacy of the procedure and the complication rates are very comparable. Where robotics helps patients is with blood loss, length of stay, and catheter drainage time.
Is there anything else you would like to highlight?
The takeaway message is that education is extremely important. We don't just blindly fine people for not doing things. Once we identify a problem, we sit down with the physician, educate them, and do re-audits of their charts to make sure that they have learned and are compliant. It makes documentation better, improves coding, improves reimbursement, and improves communication among physicians. There is a very big upside to try to bring people into line with things.