In 2001, robotic surgery came to the forefront in urology. Many, particularly younger urologists are learning the skills necessary to robotically remove cancerous prostate glands. Many urological surgeons have voiced tremendous negativity about robotic surgery saying it is a passing fad, that the costs are actually greater, that they were unsure of the results as far as a cancer is concerned, that it may not reduce the incidence of erectile dysfunction in those who have nerve-sparing surgery, urinary control may not be better, that there is a higher incidence of margins-positive and that it is extremely difficult to learn and the learning curve is long.
On the other hand, assuming the surgeon is skilled, the procedure is just another operative procedure using different skills and instrumentation to cure prostate cancer with the advantage that the morbidity is reduced, the hospitalization is reduced, probable less blood loss and better visualization of the neurovascular bundles.
As our surgeons do more and more of these procedures, the one-time, 6-8 hours radical robotic nerve-sparing prostatectomy is now becoming a 2.5 hour operation, similar to the standard open prostatectomy. As urologic surgeons do more of these procedures, the incidence of margin-positive will decrease.
Basically, we cannot stop progress. Patients desire this new technique, which, I believe, is at least as good as, if not better than, the standard nerve-sparing radical prostatectomy. Those of us older than 45 should not fight progress and should allow the younger, under-45 surgeons to hone their skills and continue to improve a technique that will remain in the future.
Every new technology in the past 25 years in which urologist either felt that the technology would diminish their practice and/or was an ineffective procedure has passed the test of time. Lithotripsy, ureteroscopic stone manipulation and laparoscopic renal surgery are now a standard of care, accepted by all and taught in our urological residency training programs.
Robotic surgery will do at least as well, if not better than, the above procedures. Sixty per cent of radical nerve-sparing prostatectomies are now being done robotically, and I am sure a larger percentage will be done in the very near future.
Robotic surgery will replace most open pelvic surgery including hysterectomy and radical hysterectomies for cancer as well as renal surgery with partial and total nephrectomy. I urge urologic surgeons to get used to robotics. Patients want it. It is good for them, and it is probably good for urology and urologic surgeons. (September, 2008)
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