Robot, Robot, Burning Bright …

RALPH BLUM

If you have read some of my previous blogs you probably will be aware that I am not an advocate of radical prostatectomies in any shape, way or form. But since the robot-assisted laparoscopic prostatectomy (RALP) is the flavor of the month with both prostate cancer patients and their urologists, it seems pertinent to zero in on some of the information you need to know if you are considering this procedure.

 

There is something alluring about the idea a surgeon sitting at an attached console and manipulating a robot’s mechanical arms to perform this highly complex and intricate operation. But if you are under the impression that it is the robot making those small incisions in your abdomen to perform the operation, think again. It is the skill of the surgeon that will preserve (or not) your sexual function by avoiding damaging the miniscule nerves that run along each side of the prostate and control erections.  It is the surgeon’s experience that will (or not) protect the sphincter that allows you to retain urinary control. And it is the surgeon’s expertise that will ensure a positive, long-term outcome.

 

RALP has advantages over other forms of radical prostatectomy in terms of pain, blood loss, and recovery time. No small thing. But keep in mind that any complex surgery comes with risks: the small risk of heart-attack, stroke, blood clots in the legs that could travel to the lungs, reactions to anesthesia, and infection of the incision sites. And because there are many blood vessels near the prostate gland, there is also the risk of prolific bleeding, in which case blood transfusions might be necessary—which carry their own risk. But your risk level depends primarily on your overall health, your age, and the skill of your surgical team.

 

Having said that, I realize how tempting it is to go for closure. But is surgery—robotic- assisted or otherwise--really closure? Statistics show that is debatable.  And in terms of the side-effects that most men are concerned about (urinary incontinence and impotence)  there is little difference between robotic-assisted surgery and laparoscopic surgery performed without the robot. Bottom line, the most important factor with either procedure is the surgeon’s experience and skill.

 

Opinions differ about how many robotic-assisted operations a surgeon needs to perform to become really proficient, but surgeons at community hospitals rarely have sufficient experience. And you do not want to be part of a surgeon’s steep learning curve. Dr. Vipul Patel, of the Global Robotics Institute in Celebration, Florida, appears to be leading the pack having performed some 8,000 robotic prostatectomies.

 

It’s apparently hard to resist the lure of a robot. But any kind of radical prostatectomy is both costly and risky, so don’t let your natural desire for closure blind you to the risks of such a challenging surgery—especially if you are 70 or over.  In fact if you have low-risk prostate cancer and are over 65, you have a 20% chance of dying of cancer in the next 20 years compared to a 60% chance of dying of something else. So buyer beware!