Robotic-assisted prostate surgery offers better cancer control

An observational study has found that prostate cancer patients who undergo robotic-assisted prostate surgery have fewer instances of cancer cells at the edge of their surgical specimen and less need for additional cancer treatments like hormone or radiation therapy than patients who have traditional "open" surgery. While the robotic surgery method has higher upfront costs, these may systemically be offset by a reduction of additional cancer therapy costs after surgery due to better cancer control outcomes.

http://www.sciencedaily.com/releases/2014/02/140228160626.htm?utm_source=feedburner&utm_medium=email&utm_campaign=Feed%3A+sciencedaily+%28Latest+Science+News+--+ScienceDaily%29

Thanks Steve. Not the sharpest knife in the drawer when it comes to computers, etc.

There is no doubt that the skill (or art) of the surgeon is a major predictor of the out come. Much the same as the skills of anyone, be they a policeman, auto mechanic,rocket scientist etc. However, I am a great believer that the tools or "arrows" these folks have at their disposal has a profound influence on the final result.

I read that and cringed. I had open RP at my docs suggestion due to being Gleason 9. I had EPE and positive margin at base where SVs enter and were involved. Ten nodes removed all negative. I don't know how pos margins can be avoided when PCa has extended through the capsule. Anyone have any thoughts on this?
Bob

You can say it's the archer and not the arrow, but I'd rather have the best archer with the best arrow.

I remember well the day I was wheeled into the O.R. I saw this rather imposing piece of equipment, that was the robot, covered in plastic sleeves. Then one of the the O.R. techs bumped the arm of the machine. He was quickly admonished, "_____ you bumped the equipment!" by the individual who had wheeled me in. I often wonder if that had changed any of the settings, etc. on the robot?

Given the chance the patient might see something unsettling like that imposing equipment (or worse yet, it getting bumped accidentally!), I would have guessed that it would be common to administer the anesthesia in a room separate from the O.R., as was the case with me.

I have read, and my urologist/ surgeon also told me, that the loss of blood is less (though not statistically significant) with open than with robotic.

yegbert said...
Given the chance the patient might see something unsettling like that imposing equipment (or worse yet, it getting bumped accidentally!), I would have guessed that it would be common to administer the anesthesia in a room separate from the O.R., as was the case with me.

I have read, and my urologist/ surgeon also told me, that the loss of blood is less (though not statistically significant) with open than with robotic.

I'm not absolutely sure about this, but my understanding is that blood loss with the robot is MUCH LESS than with the open method. That is one more of the robot's advantages.

I suppose different places have different protocol with the anesthesia. I remember being wheeled down a short hallway and the double doors to the OR being bumped open -- and, from my position laying on the gurney, I saw the robot sitting along the wall.

They immediately transferred me to the surgical table and, within "moments," I found myself being wheeled into my hospital room -- EIGHT hours later. LOL

Chuck

Resident of Highland, Indiana just outside of Chicago, IL.
July 2011 local PSA lab reading 6.41 (from 4.1 in 2009). Mayo Clinic PSA Sept. 2011 was 5.7.
Local urologist DRE revealed significant BPH, but no lumps.
PCa Dx Aug. 2011 at age of 61.
Biopsy revealed adenocarcinoma in 3 of 20 cores (one 5%, two 20%). T2C.
Gleason score 3+3=6.
CT of abdomen, bone scan both negative.
DaVinci prostatectomy 11/1/11 at Mayo Clinic (Rochester, MN), nerve sparing, age 62.
My surgeon was Dr. Matthew Tollefson, who I highly recommend.
Final pathology shows tumor confined to prostate.
5 lymph nodes, seminal vesicles, extraprostatic soft tissue all negative.
1.0 x 0.6 x 0.6 cm mass involving right posterior inferior,
right posterior apex & left mid posterior prostate.
Right posterior apex margin involved by tumor over a 0.2 cm length, doctor says this is insignificant.
Pathology showed Gleason 3 + 3, pT2c, N0, MX, R1
adenocarcinoma of the prostate.
Prostate 98.3 grams, tumor 2 grams. Prostate size 5.0 x 4.7 x 4.5 cm.
Abdominal drain removed the morning after surgery.
Catheter out in 7 days. No incontinence, occasional minor dripping.
Post-op exams 2/13/12, 9/10/12, 9/9/13 PSA <0.1. PSA tests now annual.
Firm erections now briefly happening in early mornings, 2 years post-op.

A couple of observations/comments:
It's been a while now since the robot first appeared, thus there are more stats available for robot patients to make good comparisons.
More surgeons have been doing more robot surgeries, thus one would hope the overall skill level is going up.
And if more robots then fewer open surgeries are being done this may affect the stats.

The robot has also been improved, eg 3D images now not just binocular, possibility of robot arms giving feedback/sensation in surgeons fingers is on the cards.

Robot is capabale of much more delicate and finer movement and actions than fingers and thumbs. I have seen various videos of assorted open surgeries where surgeon is anything but delicate when using just their hands.

Length of hospital stay can be an important factor in a patient's recovery, especially in relation to hospital acquired diseases/infections. (I recall my dad talking about surgery 100 years ago when he was training to be a doctor when the norm was that EVERY wound went sceptic. We've come a long way since then, but I know of several people who have become seriously ill as a result of catching something in hospital after surgery.)

(In my own case while it would have been nice on the one hand to have been pampered by nurses for several days, it was incredibly boring being in hospital, and nor was it easy for my wife to visit etc, it felt so much more comfortable being back in my own bed, using my own bathroom, eating and drinking exactly what I wanted, having all books, music, TV, computers etc where I wanted, even simple things like having a decent view out of the window.

@Break60 - you can have clean margins with EPE as the margins are determined by the surgeon when they choose where to cut, if they cut a long way away from the actual prostate then the cancer can still be within the margin while not within the gland.

I was prepped for surgery in a separate room and had a long chat with the aneathetsist and nurses about what they were doing. Also before surgery we were given the opportunity to watch a video of the procedure and equipment so we would know what it looked like etc, and were even given an old robot arm to fiddle with so we could see how it could move in so many more directons than a finger.

But I agree with all those that say that a good surgeon is best. If nothing else becasue , as it was also pointed out to me, in the event of the robot malfunctioning or the surgeon finding something very complicated or unexpected during the surgery they might have to switch to open, in which case you will need a surgeon that is also good with their fingers.

It does though surprise me that with all the need for a surgeon to be skilled with his hands, there is always this idea, that is usually true, that they have terrible handwriting!!

Alf

Well said Alf.

If you are going to have open, try look at surgeons hands before committing. If they are big and stubby, ask if robotic is available. I actually did look at my surgeon's hands, he could have done hand commercials…… As I was writing above, about if we could get the robot to share his feel, etc,, it was in the back of my mind that, as Alf said, I bet that is coming. Im not that sure about the blood loss issue. I sense its moot, as a finer class of open surgeons, replace some of the old curmudgeons. My local urologist, since fired, had retired from surgery when I was diagnosed in 09. He had no problem doing open surgery a week after biopsy, if he could get it scheduled. he told me that right after he shrugged off ED as a price you pay if you want it cured. I had one 4" scar period, 48 hrs in hospital, walked 2 miles back to apt on release, wrestled a bear, chewed barb wire,……. er eh, dear, where are my meds. Ok one of the last 3 was a fib…. Ps don't tell me Im a funny guy or I will do my Joe Pesci schtick.