Robotic-assisted laparoscopic radical prostatectomy – Better or just different?

Since it was first introduced in 2003, there’s been a sharp increase in the number of men who have robotic-assisted laparoscopic radical prostatectomy, which is often referred to as RALP.

This type of surgery is really just a laparoscopic radical prostatectomy that is performed using a robotic device.

The device is a machine with robotic arms that is known as the da Vinci system.

How it works

  • The system is controlled by a surgeon who sits before a panel in the operating room (near the table where the man is lying)
  • A surgical cart has three or four arms with a laparoscope and two to three surgical tools
  • There are master controls that the surgeon uses to operate the arms

Pros of robotic-assisted laparoscopic radical prostatectomy

  • Less invasive (only requires several small incisions in the man’s abdomen)
  • Less pain than traditional prostate cancer surgery
  • Less blood loss
  • Shorter recovery time
  • Tremor filtering and increased range of motion

Cons of robotic-assisted laparoscopic radical prostatectomy

  • Surgeon can’t feel the prostate gland
  • No long-term studies (a problem with all newer procedures)
  • May not be available in all hospitals
  • Men still need to wear a catheter

Know the surgeon’s skill level!

Some have suggested that a surgeon must perform at least 250 traditional radical prostatectomies to master robotic surgery for prostate cancer.  That number is much higher (750) for laparoscopic surgeries.

No matter what type of surgery you choose, you want to make sure you have a surgeon who is proficient at that type of technique.

What you want to avoid is a surgeon who is learning how to perform RALP on your man.

Here are some questions you can ask to help assess a surgeon’s skill level:

  • How many RALPs have you performed in total?
  • How many RALPs do you perform a week?
  • Did you switch from traditional surgery to RALP? (Some suggest it’s better for the surgeon to only have performed RALP)  If yes, how long have you been doing RALP?
  • How many of your patients require additional therapy (radiation or hormone treatment) after RALP?
  • How many of your patients have positive surgical margins?
  • How many of your patients experience long-term impotence? How do you define impotence?
  • How many of your patients experience long-term incontinence?  How do you define incontinence?
  • How many of your patients have undetectable PSA levels 5 years after RALP?

Long term results

There is no compelling difference (to date) between RALP and traditional radical prostatectomy for problems like incontinence and erectile dysfunction.

Part of the problem is that there isn’t long-term data.  Another issue is that studies vary from center to center.  If only one highly proficient surgeon is performing all the surgeries, his or her skill may skew the study.

We’d love to see across-the-board, large-scale, prospective studies of multiple centers across the U.S (both large and small).

The reality is that the more surgeons perform RALP, the better they should be at it.

To give you some perspective, when traditional radical prostatectomies were first performed, incontinence rates were as high as 50%.  Now continence (defined as no pad usage for the last 4 weeks) is as high as 93% after 18 months.

Return to treatments
Radical retropubic prostatectomy
Radical perineal prostatectomy
Laparoscopic radical prostatectomy

Robotic-assisted laparoscopic radical prostatectomy, references:

Patel, VR, Chammas MF, Shah S. Robotic assisted laparoscopic radical prostatectomy: A review of the current state of affairs.  Accessed March 29, 2015.

The American Cancer Society. Prostate Cancer. Accessed March 17, 2015.

US TOO International, Inc. Pathways for new prostate cancer patients. Accessed September 1, 2008.

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