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Robotic-assisted vs. Human-only Laparoscopic Radical
Prostatectomy
Human-only laparoscopic surgery at Lexington
Medical Center is every bit the equal of robotically assisted laparoscopic surgery. The first
non-robotic laparoscopic prostatectomy done in S. C. was done at Lexington Medical Center by one of their
urologists. On 14 November 2014, Dr. Brian Willard performed the first robotic assisted prostatectomy was performed by Dr. Brian Willard.
First of all, the surgery is not performed by a
"robot"! It is performed by a highly trained human Urologist who uses a complex piece
of equipment (the robot) as an extension of his/her hands. Two questions are more important than a
robot is: (1) is the urologic surgeon a well-reputed, GOOD doctor? and (2) is the hospital
or surgi-center known to have highly desirable nursing care and emergency
support?
Because each robot and associated support
equipment costs (in 2007) some $3 million dollars & some $100,000 to $1 million per year
thereafter in "maintenance agreement" (is any of this a subterranean, forced-profit "kick
back" to the company?), few centers can afford a robot, much less to have a back-up robot
should the original one fail during your surgery. If it failed, you would be
immediately converted to human-only laparoscopic or open surgery. The "robot" is a hot
hospital "marketing" item. They hope that, in your eagerness to “get the robot”, you will
stay with them for other types of treatment if/when you get turned down for the robotic
surgery.
The real difference which you and your family will
notice and care about is the quality of institutional care (you will be sound asleep during
surgery; family will be in a comfortable waiting room during surgery) before and after
surgery.
Patient
selection:
- Condition of
abdominal cavity & pelvis: the abdominal/pelvic cavities must be "virginal" (no
previous surgery or serious intra-abdominal diseases) for intraperitoneal laparoscopic surgery
(robot). Extra-peritoneal nonrobotic laparoscopic surgery may still be possible, even with
adhesions. But traumatic or other severe pelvic scarring may even be too much for open
prostatectomy.
- Patient
size: Any really obese person (BMI greater than 35-40) is going to have an increased
risk that a laparoscopic surgery must be converted to open
surgery.
- Prostate
glands size: If the TRUS size is beyond 50cc, laparoscopic may be a
problem.
- Character of
your cancer: Certain “unfavorable” cancers are not treatable by any
surgery.
Advantages for
Urologist:
- In a multi-hour
procedure, robotics reduces Urologists surgical time in the OR by about 30
minutes.
- There is a quicker
"learning curve" for the Urologist newly learning to use robotic assisted laparoscopic surgery
than "learning curve" with human-only laparoscopic surgery.
Disadvantages for
the Urologist:
- The ability to
"feel" that tiny amounts of cancer beyond the gland are about to be cut through...tactile
sensation...is largely lost: a big disadvantage.
Advantages, if
any, for the patient:
- Operative
time: If, in fact, with your particular case, it reduces your operative time by 30
minutes (from, say, 4 hours to 3.5 hours), you would have had a little less time under
anesthesia.
- Quality of
urethral anastomosis: Statistically (but not guaranteed at all for your specific
case), there is a mildly lower percentage of postoperative anastomotic leakage in published
case collections by widely acknowledged national-class robotic-operating
experts.
- Recovery
time: Both types have statistically equal, quicker recovery time than with open
radical prostatectomy.
Quality of
support staff and conditions at the operative facility:
- Institution
culture:
What is reputation in community?
What is reputation for nursing care?
What is reputation for facilities?
What is reputation for meals (ask if they have “room service”)?
- Institutional emergency response:
Emergency room: Could you expect rapid emergency response if you "crash" in the OR or
post-operatively?
In-house hospital physicians: Are institution-employed "hospitalists" readily
available?
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TRUTH
(posted 30 August 2007; update 17 June 2015)
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