BERKELEY, CA (UroToday.com) - In centers where high utilization of robotics is required in order to amortize the investment due to the acquisition of the robot, the diversification of procedures may turn out of a paramount importance in guaranteeing a satisfactory pool of pathologies suitable for a robot-assisted approach. In fact, the robot is only an instrument allowing to further improve the quality of surgical procedures. The accuracy and the facility of the dissection and of the sutures make the robotic surgery potentially suitable for mostly all urologic surgical procedures.
In Italy, there might not be enough demand in terms of the numbers of prostate cancer patents, and this may create a stimulus to find other sustainable applications of the robotic approach. Multidisciplinarity may be a solution, but gynaecology procedures apart, there are only a few abdominal, thoracic or H&N surgical procedures clearly and beneficially suitable for this approach. As a result, the solution relies on the urologist.
Some points that should be clarified:
- The textbook procedure of the radical prostatectomy is well-standardized, frequently performed, and contains not only ablative but also reconstruction components; the procedure may be divided into steps in order to enable a gradual learning process, accordingly requiring an effort in developing skills and strategy.
- The extension of the indications moves first to renal surgery, as the benefits of robotics, especially in partial nephrectomy, are intuitive. Urogynecology is another interesting and well-known field of application.
- Simple prostatectomy turned out a very satisfactory indication for use of the robot for both surgeons and patients. Of course the very good results obtained with TURP in low prostate-volume urinary tract obstruction and by HOLEP in higher prostate-volume cases, shrinks the pool of patient candidates to this approach. Moreover, in these rare pathologies, the possibility of viewing the procedures using educational or popular video programs on the Internet becomes essential.
Even if the primary motivation determining the implementation of the robotic urologic surgery was represented by the need to ensure an adequate number of procedures, the evident clinical advantages are enough to justify the transition from open to RA surgery in the case of the simple prostatectomy.
As in our paper, the advantages of RASPS are well documented. We hope this publication will eliminate the remaining resistance against the use of robotics in urology.
On the other hand, the use of the robot for almost all urologic pathologies potentially helps to develop an ‘economy of scale,’ achieving more comparable overall costs for all non-radical-prostatectomy procedures.
Written and prepared by: Deliu Victor Matei, MD, PhD student as part of Beyond the Abstract on UroToday.com. This initiative offers a method of publishing for the professional urology community. Authors are given an opportunity to expand on the circumstances, limitations etc... of their research by referencing the published abstract.
Department of Urology
European Institute of Oncology
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20141 Milan, Italy
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Robot-assisted simple prostatectomy (RASP): Does it make sense? - Abstract
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