Overcoming the challenges of robot-assisted radical prostatectomy

Goldstraw, Miles A.; Challacombe, Benjamin; Patil, Kishor; Amoroso, Peter; Kirby, Roger

doi:10.1038/pcan.2011.37

Cited by 28 publications

(31 citation statements)

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“…Very often with salvage cases, significant intra-abdominal adhesions, dense periprostatic inflammation post URP; large prostate gland size and median lobes may alter bladder neck anatomy. This makes for a difficult urethro-vesical anastomosis [5]. This highlights the importance of a having a good robotic pelvic experience, prior to taking on salvage cases.…”

Section: Open Access Letter To Editormentioning

confidence: 99%

“…Increasingly complex cases can be taken on as the learning curve progress [5]. Very often with salvage cases, significant intra-abdominal adhesions, dense periprostatic inflammation post URP; large prostate gland size and median lobes may alter bladder neck anatomy.…”

Section: Open Access Letter To Editormentioning

confidence: 99%

“…Even though robotic, salvage surgery still has potential difficulties, these can be overcome with the robotic platform [5]. Voiding complications while on the steepest part of the learning curve are crucial to overcome [5].…”

mentioning

confidence: 99%

“…The 3-year, 5-year, and 7-year BCR-free survival rates were 79.2%, 75.3%, and 70.2%, respectively [7]. 250 cases have become a landmark for lowest positive surgical margin rates, although, it may take more experience than this to manage SRALP cases [7].Increasingly complex cases can be taken on as the learning curve progress [5]. Very often with salvage cases, significant intra-abdominal adhesions, dense periprostatic inflammation post URP; large prostate gland size and median lobes may alter bladder neck anatomy.…”

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confidence: 99%

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Salvage prostatectomy and high risk disease: push your limits - robotics is better

Goonewardene¹

2016

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Open Access Letter to Editorknown to be common, but less so than open surgery (39%) [6]. This is comparable to other robotic series. Although some patients had limited follow-up, 6 (33%) were continent and 67% were free of biochemical progression.Many SRALP patients have localised disease recurrence and therefore potentially curable disease [2]. The key to decreased morbidity SRALP outcomes are to have experienced centers and fellowship training, a standardisation of training [2]. The robotic surgery curriculum is welcomed as part of this. These centre have demonstrated the advantages of the robotic platform in the performance of salvage radical prostatectomy. This includes decreased blood loss, short length of stay and improved haptic feedback. This was confirmed with a decreasing positive surgical margin rate with each consecutive group of 50 cases, including pT3 and high-risk patients [7]. The 3-year, 5-year, and 7-year BCR-free survival rates were 79.2%, 75.3%, and 70.2%, respectively [7]. 250 cases have become a landmark for lowest positive surgical margin rates, although, it may take more experience than this to manage SRALP cases [7].Increasingly complex cases can be taken on as the learning curve progress [5]. Very often with salvage cases, significant intra-abdominal adhesions, dense periprostatic inflammation post URP; large prostate gland size and median lobes may alter bladder neck anatomy. This makes for a difficult urethro-vesical anastomosis [5]. This highlights the importance of a having a good robotic pelvic experience, prior to taking on salvage cases.Compared to open and laparoscopic procedures perioperative SRALP outcomes were positive, with low complication rates and estimated blood loss equivocal to open or lap procedures [1]. This demonstrates robotic technology can aid the surgeon in salvage prostatectomy [1]. However, experience and training are key to minimal morbidity [3]. This procedure has significant advantages over open surgery in selected patients and is an excellent alternative to other salvage therapies, and allows a broader spectrum of patients to be treated compared to open surgery [3]. SRALP also offers complete staging of high-risk prostate cancer thereby allowing optimum planning of adjuvant and salvage therapies [8]. However, many high-risk prostate cancers are subsequently downgraded or down staged on final histopathology [8], rendering the patient disease free.

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Section: Open Access Letter To Editormentioning

confidence: 99%

Section: Open Access Letter To Editormentioning

confidence: 99%

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confidence: 99%

mentioning

confidence: 99%

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Salvage prostatectomy and high risk disease: push your limits - robotics is better

Goonewardene¹

2016

SOJS

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“…Even though robotic, salvage surgery still has potential difficulties, these can be overcome with the robotic platform [8]. Voiding complications while on the steepest part of the learning curve is crucial to overcome [8]. Urinary leak identified by postoperative cystogram was common [39%] [8].…”

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Salvage Robotic Prostatectomy and High Risk Disease: What Else Can We Do?

Ss¹

2016

JOJUN

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Assessment of Out-of-Pocket Costs for Robotic Cancer Surgery in US Adults

et al. 2020

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IMPORTANCE Expensive technologies-including robotic surgery-experience rapid adoption without evidence of superior outcomes. Although previous studies have examined perioperative outcomes and costs, differences in out-of-pocket costs for patients undergoing robotic surgery are not well understood. OBJECTIVE To assess out-of-pocket costs and total payments for 5 types of common oncologic procedures that can be performed using an open or robotic approach. DESIGN, SETTING, AND PARTICIPANTS A retrospective, cross-sectional, propensity scoreweighted analysis was performed using deidentified insurance claims for 1.9 million enrollees from the MarketScan database from January 1, 2012, to December 31, 2017. The final study sample comprised 15 893 US adults aged 18 to 64 years who were enrolled in an employer-sponsored health plan. Patients underwent either an open or robotic radical prostatectomy, hysterectomy, partial colectomy, radical nephrectomy, or partial nephrectomy for a solid-organ malignant neoplasm.

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Overcoming the challenges of robot-assisted radical prostatectomy

Cited by 28 publications

References 50 publications

Salvage prostatectomy and high risk disease: push your limits - robotics is better

Salvage prostatectomy and high risk disease: push your limits - robotics is better

Salvage Robotic Prostatectomy and High Risk Disease: What Else Can We Do?

Assessment of Out-of-Pocket Costs for Robotic Cancer Surgery in US Adults

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