Using Robotic-Assisted Prostate Surgery Requires Highly Experienced Surgeons

According to an analysis of prostate cancer surgeries, surgeons need experience with robotic-assisted laparoscopic radical prostatectomy (RALP) to achieve the best results. RALP is a procedure in which a camera and instruments are inserted through small, keyhole incisions in the patient's abdomen. The surgeon then directs the robotic instruments to remove the prostate gland and surrounding tissue. It is possibly much less invasive than an open radical prostatectomy and may reduce recovery time. In general, robotic prostatectomy has less bleeding and less pain, but sexual and urinary side effects can be similar to an open radical prostatectomy.

This study included the results of 3,794 patients who had RALP performed by one of three surgeons during a six year period. Researchers found that surgeons needed to do more than 1,600 robotic surgeries to remove the cancerous prostate and enough of the surrounding tissue with a negative margin 90% of the time, meaning the tissue removed from around the tumor contains no cancer. A positive margin is when the tissue removed contains cancer, and other studies have shown that patients who had a positive margin after surgery were more likely to have the cancer come back.

What this means for patients

“A robotic prostatectomy has been shown to take less training time to learn to safely perform prostate cancer surgery compared to open and laparoscopic surgery, but we see that removing the entire tumor and a cancer-free margin with the robotic operation takes much longer than being able to perform the surgery safely,” said lead author Prasanna Sooriakumaran, MD, PhD, a visiting fellow in urology at the Weil Cornell Medical College in New York. “Our results show that it is possible to get good cancer cure rates and remove most of the cancerous tissue with this operation, but it takes a significant amount of experience.”

Questions to ask your doctor

  • What stage of prostate cancer do I have?
  • What are my treatment options?
  • Do you recommend surgery?
  • If so, what type of surgery will be done and who will be performing it?
  • How much experience do you have with this type of surgery?

For More Information

Guide to Prostate Cancer

Understanding Cancer Surgery

Basics of Cancer Surgery: Video with Robert Sticca, MD