February 24th, 2011

Robotic-Assisted Prostate Surgery: Experience Matters


According to the results of a study presented at the 2011 Genitourinary Cancers Symposium, a surgeon may have to perform well over a thousand robotic-assisted prostate cancer surgeries before becoming fully proficient at the procedure.

Treatment options for early-stage prostate cancer include surgery, radiation therapy, and active surveillance (close observation but no treatment until the cancer shows signs of worsening).

Radical prostatectomy refers to the surgical removal of the entire prostate and some surrounding tissue. Prostatectomy may be performed using traditional open surgery, in which the surgeon makes a single, long incision; or through a laparoscopic procedure (sometimes called minimally invasive surgery), in which several small incisions are made. During laparoscopy, the surgeon inserts a small video camera through one of the incisions in order to see inside the abdomen. In a variant of laparoscopic surgery known as robotic-assisted laparoscopic surgery, the surgeon sits at a console near the operating table and performs the surgery by controlling robotic arms that hold the surgical instruments.

Previous studies of robotic-assisted prostate surgery have suggested that it doesn’t take long for surgeons to learn how to perform the procedure safely. Achieving the best possible cancer outcomes, however, may require a greater amount of experience.

To assess the number of robotic-assisted prostate surgeries that a surgeon must perform before becoming fully proficient, researchers assessed 3,794 patients who were treated by one of three surgeons.

A key outcome that was considered in the study was the rate of positive surgical margins. A positive surgical margin means that cancer is found at the edge of the tissue that was removed during surgery; it may be a sign that not all of the cancer was removed.

  • The rate of positive surgical margins declined as surgeons gained experience. The lowest rates of positive surgical margins (<10%) came after a surgeon had performed more than 1,600 robotic-assisted prostate surgeries.

In a prepared statement, one of the researchers involved with the study concluded “Even for [surgeons] who do hundreds of cases per year, it takes a long time to get to the stage where they are getting the best possible cancer control results. Our results show that it is possible to get good cancer cure rates and low surgical margins with this operation, but it takes a significant amount of experience.”

Patients who are considering robotic-assisted prostate surgery may wish to seek out a surgeon who has extensive experience with the procedure.

Reference: Sooriakumaran P, John M, Leung R et al. A multi-institutional study of 3,794 patients undergoing robotic-assisted laparoscopic radical prostatectomy to determine the surgical learning curve for positive margins and operating time. Presented at the fourth annual Genitourinary Cancers Symposium; February 17-19, 2011; Orlando, FL. Abstract 102.

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Tags: Early Stage I-II (A-B) Prostate Cancer, Locally Advanced Stage III (C) Prostate Cancer, News, Prostate Cancer, Uncategorized