m
prostatectomy has become the
most commonly performed
in the United States. According to
industry analysts, 75 percent of
prostate cancer surgeries in the U.S.
were performed with the surgical robot
in 2008. That rate was 96 percent in
New Jersey.
questions concerning the benefits of
this new technology. This controversy
is due in part to the wide range of
results that have been reported in
scientific journals.
urologists are the lower complication
rate and significantly faster recovery
time. Following open prostatectomy,
the average hospital stay is usually two
to three days, blood transfusion rate is
approximately 10 percent, and use of a
foley catheter for bladder drainage is
usually required for at least two weeks.
In contrast, after robotic prostatectomy,
an overwhelming majority of patients
stay in the hospital for only one day,
the blood transfusion rate is well below
one percent, and a foley catheter is
utilized for one week. At The Cancer
Institute of New Jersey following the
procedure, 95 percent of patients are
discharged home after one night in the
hospital and no patients have received
blood transfusion to date.
cancer surgery. The exact incidence
of incontinence following radical
prostatectomy has been difficult to
assess because the definition of
surgeons use pad-free rate while others
define continence as the use of one or
less protective pads. Robotic surgeons
in general have adopted the strictest
definition for continence, which is the
pad-free rate. At most medical centers
with a high volume of
robotic prostatectomy,
this rate is in the range
of 95 to 97 percent.
More impressively, the
pad-free rate at three
months following
robotic surgery has
been 80 to 90 percent.
Thus, the return of continence
following prostatectomy appears to be
significantly faster for robotic surgery.
At CINJ, the pad-free rate at three
months is 88.75 percent, 93.2 percent
at six months, and 97 percent at
one year.
depends largely on the patient's age
and sexual function status prior to
surgery. Nerves that are important
for erection envelop the prostate.
Through its removal, these nerves are
invariably injured because they have
to be physically peeled off the prostate.
To maximize the likelihood of preserv-
ing the erection, the prostate must be
removed with the least possible trauma
to the nerves.
erection prior to surgery, the rate of
return of sexual function varies between
each surgeon and each institution. At
Johns Hopkins University surgeons have
reported a one-year potency rate of 73
percent in men with normal sexual
2000).
But at two high-volume centers, one-
year potency rate in the 90 percent
range has been reported (Finley et al.,
2005). At CINJ,
the one-year
potency rate is
93.3 percent in
patients with
normal sexual
function prior to
the surgery.
continue to
prostatectomy with their patients, one
should keep in mind the critical voices
that remain. However, as more data
continue to emerge, it is clear that
robotic prostatectomy has largely
addressed the complications tradition-
ally associated with the open radical
prostatectomy, thus making for a
substantive conversation with the
patient.
Chief of the Section of Urologic
Oncology and Executive Director of
the Dean and Betty Gallo Prostate
Cancer Center at The Cancer Institute
of New Jersey, and is also an associate
professor of surgery at UMDNJ-Robert
Wood Johnson Medical School. He
has performed more than 600 robotic
prostatectomies over the last four years
at Robert Wood Johnson University
Hospital, which is the Flagship
Hospital of CINJ.
in robotic surgery in
comparison to a dime.
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