Robotic Prostatectomy Versus Open Radical Prostatectomy
Robotic prostatectomy is a less invasive approach to prostate removal offered by our fellowship-trained surgeons at UW Health's University of Wisconsin Hospital and Clinics in Madison, Wisconsin.
While open radical prostatectomy remains a common surgical approach, the explosion of minimally-invasive surgery has introduced robotic-assisted laparoscopic radical prostatectomy as a viable surgical approach to prostate cancer removal.
Increasing Use of Robotic Technique
As one of the first centers in Wisconsin to adopt robotic technology, we have seen our use of the robot increase to more than 80 percent of all radical prostatectomy cases being done at our institution. Nationally, 60 percent of all radical prostatectomies were performed robotically in 2007 and it is estimated that this number will continue to increase with time. Some patients may not be candidates for the robotic procedure.
Available medical literature suggests the duration of robotic prostatectomy procedures decreases with surgeon experience and skill. At UW Hospital, where nearly 1,000 procedures have been performed, the mean operative time for our first 50 cases was 212 minutes. This has since been reduced significantly and the procedure can now regularly be completed within two hours.
Blood Loss and Transfusion
As with most laparoscopic techniques, we find robotic prostatectomy generates less blood loss than the open technique. More significantly, a robotic approach typically eliminates the need for blood transfusion.
Length of Hospital Stay
The incision required for robotic prostatectomy is smaller than that of the open technique, which results in less postoperative pain and hospital stays that are approximately half as long (usually about a day for robotic prostatectomy patients).
The goal of both open and robotic techniques is to completely remove the prostate cancer. Our publication (Seminars in Urologic Oncology, 2008) demonstrates similar cancer control rates between the open and robotic approaches.
Continence and Potency
Two important post-surgical factors for prostatectomy patients are continence and sexual potency. Current data shows that at our institution among fellowship-trained surgeons, outcomes after both robotic and open techniques are excellent and roughly equivalent in terms of post-surgical continence and sexual potency.
Functional and oncological outcomes all appear to be equivalent when comparing robotic prostatectomy to open radical prostatectomy. However, recovery is more rapid in patients being treated with the robotic approach. Experience and surgeon volume play an important role in outcomes providing an advantage to patients who are treated at UW Hospital and Clinics. UW Health surgeons believe future trials will likely show improved outcomes as robotic experience grows.