Robotic radical prostatectomy-a minimally invasive therapy for prostate cancer: results of initial 530 cases

Abstract

Context: In 2000, the number of new cases of prostate cancer was estimated at 5 13 000 worldwide [Eur J Cancer 2001; 37 (Suppl 8): S4]. In next 15 years, prostate cancer is predicted to be the most common cancer in men [Eur J Cancer 2001; 37 (Suppl 8): S4]. Radical prostatectomy is one of the most common surgical treatments for clinically localized prostate cancer. In spite of its excellent oncological results, due to the fear of pain, risk for side effects, and inconvenience (Semin Urol Oncol 2002; 20: 55), many patients seek alternative treatments for their prostate cancer. At Vattikuti Urology institute, we have developed a minimally invasive technique for treating prostate cancer, which achieves oncological results of surgical treatment without causing significant pain, large surgical incision, and side effects (BJU Int, 2003; 92: 205). This technique involves a da Vinci™ (Intuitive Surgical ®, Sunnyvale, CA) surgical robot with 3-D stereoscopic visualization and ergonomic multijointed instruments. Presented herein are our results after treating 750 patients. Methods: We prospectively collected baseline demographic data such as age, race, body mass index (BMI), serum prostate specific antigen, prostate volume, Gleason score, percentage cancer, TNM clinical staging, and comorbidities. Urinary symptoms were measured with the international prostate symptom score (IPSS), and sexual health with the sexual health inventory of males (SHIM). In addition, the patients were mailed the expanded prostate inventory composite at baseline and at 1, 3, 6, 12 and 18 months after the procedure. Results: Gleason seven or more cancer grade was noted in 33.5% of patients. The average BMI was high (27.7) and 87% patients had pathological stage PT2a-b. The mean operative time was 160 min and the mean blood loss was 153 cm3. No patient required blood transfusion. At 6 months 82% of the men who were younger and 75% of those older than 60 years had return of sexual function and 64 and 38%, respectively, had sexual intercourse. At 6 months, 96% patients were continent. Where next?: This procedure is safe and effective in managing patients with clinically localized prostate cancer. However, the surgical robot has a significant prize tag attached and not every center has access to the technology. In future, hopefully, the robot will become smaller, and cheaper to allow wide acceptance of this procedure.

Keywords

• Laparoscopy; Prostate cancer; Radical prostatectomy; Robotics