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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:

  1. 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.
  2. 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.
  3. Prostate glands size: If the TRUS size is beyond 50cc, laparoscopic may be a problem.
  4. Character of your cancer: Certain “unfavorable” cancers are not treatable by any surgery.

Advantages for Urologist:

  1. In a multi-hour procedure, robotics reduces Urologists surgical time in the OR by about 30 minutes.
  2. 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:

  1. The ability to "feel" that tiny amounts of cancer beyond the gland are about to be cut through...tactile largely lost: a big disadvantage.

Advantages, if any, for the patient:

  1. 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.
  2. 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.
  3. 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:

  1. 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”)?

  2. 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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(posted 30 August 2007; update 17 June 2015)