Advantages of robotic prostatectomy

The honest starting point

There has not been a randomised controlled trial directly comparing open and robotic prostatectomy, and there is unlikely to be one. So the comparison is based on large groups of patients and on the experience of high-volume surgeons. With that in mind, here is what the evidence and Dr Kooner's experience suggest.

Cancer control and function

• Cancer cure rates after robotic prostatectomy are excellent in published series.
• Nerve sparing for erections is generally easier because the surgeon can see the small nerves at 10 times magnification and dissect more precisely.
• Continence (urinary control) results, both early and longer term, are very good in published series.

Recovery

• Less time in hospital - usually one or two nights, instead of longer stays after open surgery.
• Faster return to work - desk-type work is usually possible within a few weeks.
• Less pain - the cuts are small, so there is less tissue trauma.
• Catheter is usually removed around day 5 or 6.

Safety

• Less bleeding than open surgery, because the gas pressure inside the abdomen reduces oozing from small veins.
• Lower infection rate, because the cuts are small and the abdomen is not left open during surgery.
• Lower stricture rate at the join between the bladder and the urethra. The robot allows a very precise stitched join.
• Across Dr Kooner's first 3,000 robotic cases, the blood transfusion rate has been zero.

What matters more than the technology

It is important to be clear: a poor robotic operation can be worse than an excellent open one. The technology helps, but the most important factor is the surgeon doing the operation. It is reasonable, and recommended, to ask any surgeon about their own results before agreeing to surgery.