Robot-assisted surgery may be safe, but comparisons to other treatments and quality-of-life data lacking

Robot-assisted radical prostatectomy (RARP) is the most common surgical technique in the U.S. to treat localized prostate cancer, but few studies have examined post-surgical complications—until now. According to a recent study in European Urology, RARP is safe over the long term, with a complication rate of about 10% at one medical center.

Researchers at Henry Ford Hospital followed more than 3,300 patients between January 2005 and December 2009 and found that there were 368 complications in 326 of the patients. Most complications, such as intestinal obstruction, urinary tract infection, stomach pain, and internal bleeding, were considered minor and occurred within 30 days of the surgery. Of note, the study did not assess the procedure’s effects on urinary continence and erectile function, critical quality-of-life issues that patients need to consider prior to surgery. This is a major shortcoming of the study.

Older men with higher prostate-specific antigen (PSA) and Gleason scores, as well as those men with other medical problems, such as heart disease and gastroesophageal reflux disease, were more likely to suffer complications.

During RARP, a surgeon uses remote control to manipulate the robot’s arms, which are tipped with miniature tools, and remove the prostate through a tiny incision. The entire surgical team can view the operation using a 3-D monitoring system. Claimed benefits of RARP include less surgical trauma and shorter hospital stays (about one day in this study) and recovery times. But experts say that it can cost up to $2,000 more per patient compared with other surgical methods.

The researchers emphasized that surgical results depend on the experience of the surgeon controlling the robot, not the robot itself. In this study, the two lead surgeons had performed thousands of RARP procedures; less-experienced surgeons may have higher complication rates. The study did not compare RARP to other procedures, so whether it causes fewer complications than, say, an open prostatectomy or proves better at controlling cancer remains unclear.

Source: Argawal PK, Sammon J, Bhandari A, et al. Safety Profile of Robot-Assisted Radical Prostatectomy: A Standardized Report of Complications in 3317 Patients. European Urology 2011;59:684-98. PMID: 21324583.

Published May 24, 2011