- Despite open RP (ORP) provides long-term oncological control of up to 15 years, the emergence of RALRP made laparoscopic dissection technically easier. Minimally invasive incisions create less postoperative pain, reduce blood loss, and decrease length of hospital stay. Surgeons who prefer an open technique claim the ability to alter surgical technique in real-time based on intraoperative visual and tactile assessment of tumor stage. Urinary incontinence and erectile dysfunction are the 2 major concerns for patients after radical prostatectomy. Continence rate is reported to be 90% after ORP and up to 96% after LRP and RALRP. Therefore, RALRP seems to have some advantages in recovery of potency over other RP techniques.
In experienced hands these techniques yield the same result (trifecta). More important than the approach is the surgeon performing the intervention.
I agree completely with both the above answers however the cost factor is very imprortant.
The medical ensurance companies in South Africa and I am sure other countries are very relactunt to pay for the RALRP.
with an initial investment of close to USD10,000,000 you need to consider the number of patients and thepayment by medical ensurance to justify the inestment.
I am Open Radical Prostatetctomy since 1995 and in 2011 switched to Robot Assited RP. I agree with the opinions given by the previous authors and feel that unique benefit of the Robot Assisted Surgery is Surgeon's comfort . In my opinion it adds more years to surgical skills. The only problem in my country is the high cost but can be circumvented by subsidizing the cost by govt or institutions.
From a pathologist's point of view, there's no difference between the two techniques, if you guarantee an adequate evaluation of surgical margins and extraprostatic extension (EPE) of the neoplasm. The neverending problem of radical prostatectomies is the correct balance between wider resections with safe margins and nerve-sparing.
In my 22 years practice I have been always working with O/LRP specimens, so I cannot make comparisons with robotic surgery by means of pathology data. However, I often noticed wide resections without EPE, also in RP perfomrmed by skilled urologists. As a matter of fact, some urologists argue that RALRP has an higher frequence of positive margins.
In my opinion, there is no sensible difference and the choice should be made considering cost factors and patients benefits.
I agree with all above. In addition it is good for the ego of the Institute! Nothing else!!! If your competitor or enemy has it you also try to acquire it!!!
You can see our discussion on open vs. robotic radical prostatectomy here:
http://connection.asco.org/magazine/current-controversies-oncology/robot-assisted-versus-open-radical-prostatectomy-costs-and
