Robotics in urology leads to decreased surgical and medical complications

Mani Menon, MD Detroit, Michigan, USA presented "The Role of Robotics in Urology" as the AUA Lecture at the plenary session of the EAU on Friday March 23, 2007.

He started with a 3-D video of a robotic laparoscopic radical prostatectomy. His technique was discussed with the video, which was received with applause. Dr. Menon has completed 3,100 of these cases. Despite no clear evidence that robotic RP has no huge advantages over open surgery, there is a significant growth in this market. The market is primarily coming from patient "advertising" to other patients by word of mouth and use of the internet. The perceived benefit is likely based upon decreased blood loss and quicker recovery. He hypothesized that this leads to decreased surgical and medical complications. Complications have a negative impact on hospital reimbursement. Based upon Medicare data, Begg in the NEJM in 2002 found that the complication rate from open radical prostatectomy was 28-35%. In a study by Dr. Lu-Yao, the surgical complication rates were virtually identical and medical complications were about 13-20%. Pure laparoscopic prostatectomy series report complication rates of about 11%. In his robotic data, medical complications were <1%. Thus, while surgical complication rates are not very different, medical complications are much less. However, he pointed out that this was not randomized data, but with the large difference (>20%) statistical methods suggest that randomized trials are not necessary to validate the difference. The difference between robotic and lap may need better study, since only a 10% difference in medical complications exist.

He stated that the benefits of minimally invasive surgery are physiological as well as surgical. Physiological benefits are more evident for complex procedures than simple procedures. Thus, the future of robotics in general, may be in making complex minimally invasive surgery safer across multiple surgical procedures. He did point out that his views are his own and do not reflect those of the AUA.

By Christopher P. Evans, MD