Summary
December 31st, 2008
Summary of Laparoscopic/Robotic Prostatectomy
- Only advantage is cosmetic
- Extremely demanding procedure (like trying to build a ship in a bottle)
- Very difficult to learn (min 100-200 cases; 400-500 to be an expert)
- Takes at least twice as long as open surgery
- Requires general anesthetic with paralysis
- No lymph node dissection
- Loss of all tactile feel for surgeon
- Added technical complexity and expense
- Blood loss is not significantly different than open surgery by an experienced surgeon
- No significant benefit in hospital length of stay
- Some studies suggest an increase in positive margins
- No advantages in potency and continence and some studies are worse
Summary of Standard Nerve Sparing Prostatectomy (Open)
- Small midline incision below umbilicus (belly button) - no muscles cut
- Epidural regional anesthetic is safer than a general with paralysis
- Takes half as long as laparoscopic/robotic surgery (approx 2 hours)
- Rarely requires a blood transfusion
- Pelvic lymph node dissection routinely performed
- Surgeon retains full tactile feel.
- Patients typically in hospital for only two nights.
- Excellent recovery of urine control and erectile function
Summary Recommendations
- Radiation therapy – best for men 70 yrs or older with small low grade tumors or younger men with serious medical contraindications to surgery
- Surgery – best for younger men or older men with aggressive tumors in relatively good health
- Surgical success is directly related to the experience of the your surgeon – be it open, laparoscopic or robotic