Da Vinci Robot: Best Choice For Prostate Surgery?

Prostate cancer (PCa) is the most common non-skin cancer in men - about 30 percent of all cancers are prostate and 15 percent of men are likely to get it.

Radical prostatectomy has the highest cure rate for an organ-confined disease of all treatments although 10-20 percent have additional prostatic disease after pathologic evaluation.

Traditionally, surgery has been done ?open? (retropubic or perineal), but since 1997 the laparoscopic approach has gained acceptance. Around 2001, the robotic approach started to become idealized. By 2005, about 20 percent of radical prostatectomies were performed with the da Vinci? surgical system from Intuitive Surgical. Although the da Vinci robot was named after Leonardo da Vinci, who made the first robot, the term was coined by Capek in a Czech play in 1921. Technically, the da Vinci? Surgical System is not technically a robot, it?s a ?remote computer assisted tele-manipulator.?

Robotic prostate surgery has some advantages for the patient. During surgery, patients tend to lose less blood, require fewer transfusions (1-2 percent instead of 5-10) and have shorter catheterization times. The latter can mean less infection, less urinary extravasation and a faster return to continence for patients. Patients also suffer less post-op pain because of a shorter incision, which helps them resume normal activities more quickly (within 92 hours instead of 4 weeks) as well as a shorter hospital stays (1.2 days instead of 2.5).

Still, controversy exists about the advantages, disadvantages and cost-effectiveness of the robot. All approaches (open, laparoscopic or robotic) provide similar overall health and quality of life outcomes: positive margins (2-19 percent); Prostate-Specific Antigen (PSA) recurrence free survival (80-95 percent after 3 years); continence at one year (80-95 percent); potency at one year (55-85 percent); and overall complications (5-10 percent). They are also similar in cost, so doctors select one approach over another based upon the patient situation and achieve similar results.

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