Year : 2016 | Volume
: 32 | Issue : 4 | Page : 253--254
Open versus robotic prostatectomy
Associate Editor, Indian Journal of Urology, Department of Urology, Christian Medical College, Vellore, Tamil Nadu, India
Department of Urology, Christian Medical College, Vellore - 632 004, Tamil Nadu
|How to cite this article:|
Kumar S. Open versus robotic prostatectomy.Indian J Urol 2016;32:253-254
|How to cite this URL:|
Kumar S. Open versus robotic prostatectomy. Indian J Urol [serial online] 2016 [cited 2021 Oct 22 ];32:253-254
Available from: https://www.indianjurol.com/text.asp?2016/32/4/253/191233
Ever since the beginning of evolution, humans have been making machines to make their life/work easier with each machine being more complex and better than its predecessor. In surgery, minimally invasive access through laparoscopy was followed by robot-assisted laparoscopy. Surgical robots were first introduced in 1985 (PUMA 560 robotic surgical arm) for a neurosurgical biopsy. In 2000, the da Vinci® system was the first surgical robot approved by the US-FDA for laparoscopic surgery. The minimally invasive nature of the surgeries, the three-dimensional optics, wide range of movement of instruments, and better ergonomics, especially deep in the pelvis, have never been doubted. However, whether this makes a difference in the oncological and functional outcomes has been debated endlessly till now in the absence of a randomized, controlled trial.
A recent publication has been widely discussed in the lay and academic media. A randomized, controlled trial, the first on the subject of open versus robotic prostatectomy, was published in the Lancet.  A total of 326 men with localized prostate cancer were randomized, and 252 of them completed the 12 weeks of follow-up. The outcomes following radical prostatectomy by either method did not show any statistical difference with regard to sexual function, urinary function, and positive surgical margins. The authors concluded that the patient needs to choose an experienced surgeon whom they trust rather than the surgical approach. The 2 years end results of this study will be awaited.
The Annual Conference of Urological Society of India is around the corner. The video session of the conference has been flooded nearly exclusively by papers on robotic surgery. The ease of production and the high quality of these videos have made it difficult for other papers to get selected for this category. Urologists love and embrace new technology and despite the prohibitive acquisition, maintenance cost to the hospital, and disposables costs to the patient, the da Vinci Robot is becoming ubiquitous even in a cost-conscious developing country like ours. There are now more than thirty instillations in India and the numbers are ever increasing. The Indian Journal of Urology has been awarding a prize for the best paper on robotic surgery for the last couple of years to promote scientific literature on the subject from our country. I quote from Yates  "For a disease that we often may not have to treat (but do), for an operation that does not necessarily improve outcomes, and for the significantly increased health-care expenditure that using a robot induces, one might muse that the da Vinci robot would not have been as well embraced if stricter technology regulatory bodies existed (akin to the pharmaceutical industry)."
In this last journal issue of 2016, we have a symposium on newer treatment options for metastatic carcinoma prostate. Six new drugs have been approved in the last decade for the treatment of this disease. Dr Balaji has put together this symposium looking at the evidence for the use of these novel agents and their sequencing in the treatment of this lethal disease. Moreover, we have two interesting original articles presenting Indian data which is often lacking. The first is an audit of early complications after radical cystectomy on more than 200 patients from SGPGI, Lucknow, and the second presents uroflowmetry nomogram for healthy Indian men. Additionally, an article from IKDRC, Ahmedabad presents a study on how novice urologists could be trained in the art of retroperitoneal laparoscopic nephrectomy using standard protocol and surgical techniques with effective mentoring. Standardizing training in laparoscopy and improving its availability would be very welcome.
|1||Yaxley JW, Coughlin GD, Chambers SK, Occhipinti S, Samaratunga H, Zajdlewicz L, et al. Robot-assisted laparoscopic prostatectomy versus open radical retropubic prostatectomy: Early outcomes from a randomised controlled phase 3 study. Lancet 2016;388:1057-66.|
|2||Yates DR, Vaessen C, Roupret M. From Leonardo to da Vinci: The history of robot-assisted surgery in urology. BJU Int 2011;108:1708-13.|