Researchers recommends robotic prostatectomy over traditional open surgery method

While sharp debate continues among medical professionals as to whether a radical prostatectomy performed with the assistance of a robotic device is more beneficial than the traditional open surgery method, research just published by investigators at The Cancer Institute of New Jersey (CINJ) shows new evidence supporting the safety of the robotic procedure - including what is believed to be one of the lowest complication rates to date. CINJ is a Center of Excellence of UMDNJ-Robert Wood Johnson Medical School.

Robotic prostatectomy allows a surgeon to look through a set of three-dimensional goggles at a console, while controlling a set of robotic arms across the room that maneuver instrument tips the size of a dime. Studies at high-volume centers have shown that the robotic procedure, which has become more commonplace over the past decade, results in a shorter hospital stay, less blood loss, and faster recovery of sexual and urinary functions compared to the traditional surgical method of radical retropubic prostatectomy. In 2008, 60 percent of radical prostatectomies performed in the U.S. were completed with the robotic method (British Journal of Urology International, 2008).

Isaac Yi Kim, MD, PhD, chief of CINJ's Section of Urologic Oncology and associate professor of surgery at UMDNJ-Robert Wood Johnson Medical School, has performed over 650 robotic prostatectomies over the last five years. This latest study, which appears in the August online issue of the Journal of Endourology ahead of the September print edition (Vol. 24, No. 9), retrospectively examined the medical records associated with the first 200 procedures performed (between January 2006 and December 2007) by Dr. Kim at Robert Wood Johnson University Hospital -- the Flagship Hospital of CINJ. The patients were divided into four groups according to order of case number. Complications both during and after surgery were determined according to Clavien classification, which is the common scale used to help identify level of surgical complications.

Overall, 24 men (12 percent) experienced various complications either during surgery or following the procedure for more than one year. Five of the men experienced complications during surgery and 19 exhibited postoperative complications.

According to Clavien classification, nine of these patients were established as grade I, which is designated as any deviation from the normal course of the operation without the need for therapy. An additional nine men were classified as grade II, which is defined as complications requiring treatment with drugs. Six men were listed as grade IIIb complications, which is identified as complications requiring surgical, endoscopic or radiological intervention. The category is further divided into "a" and "b" based on the need for general anesthesia. Grade IV indicates life-threatening complications and grade V represents patient death due to complications. In this study, there were no grade IV or V complications identified among the group.

No significant differences were reported between the group with complications and the group without in terms of age, body-mass index, biopsy Gleason score and operative time. The study did show however, that those patients who experienced complications did have a higher prostate specific antigen level, larger estimated blood loss and longer hospital stay.

Mean blood loss was measured at a mean 189 milliliters, but there was no need for a blood transfusion for any of the 200 patients during the procedures.

"Many studies on negative surgical outcomes related to robotic prostatectomy have been reported, but we believe to date, our study is demonstrating one of the lowest overall complication rates of 12 percent without any grade four or five complications," said Kim, who also is the executive director of the Dean and Betty Gallo Prostate Cancer Center at CINJ and senior author of the study. "And as we continue to analyze patient outcomes after every 50 procedures, we are able to better recognize and address adverse trends in order to improve safety, thus helping to provide ideal outcomes for patients undergoing robotic prostatectomy."

SOURCE British Journal of Urology International