Researchers from Duke University Medical Center and the University of Florida have reported that patients undergoing laparoscopic robotic prostatectomy (LRP) have similar functional outcomes as patients undergoing perineal prostatectomy (PP). The details of this study were presented at the 2007 meeting of the American Urological Association in May.[1]

The Da Vinci Robotic Surgical System for performing LRP was introduced in 2000. This technique has become very popular in some medical centers and at the present time it is estimated that more than 10% of all prostatectomies are performed by LRP. The purported advantages of this technique are that it allows surgeons to perform prostatectomy with minimal blood loss and with shorter recovery time. In a recent study from Duke University, LRP was associated with an approximate $1,000 increase in surgical cost over conventional RP but this was offset by lower hospitalization costs. However, there is still controversy over whether or not LRP is superior to conventional RP and no randomized trials have been performed or are being planned. Thus, physicians and patients have to rely on non-randomized comparisons to help decide if LRP is appropriate therapy for prostate cancer. One of the main reasons many younger patients are selecting LRP is the belief that this technique will preserve erectile function. However, there are no data to substantiate this claim.

These authors compared health related quality of life parameters as shown in the following table:

These authors conclude that longer prospective studies were needed to confirm these observations and to evaluate recurrences.

Comments: These data, as other, do not show major differences in functional outcome between perineal prostatectomy and robotic prostatectomy. Most of the studies at the AUA meeting concerning robotic surgery were observational one arm studies documenting the safety and relative effectiveness of this approach. An interesting study at this meeting evaluated sexual-health misinformation on robotic prostatectomy websites.[2] They reviewed 75 web pages from university and community based practices that performed robotic prostatectomy. They found that one third of these sites had no information on erectile function. The majority of sites stated that robotic surgery had better erectile function outcomes compared to open prostatectomy “despite the absence of scientific data to support these claims.” These authors concluded that “This misinformation is giving patients who are considering radical proatatectomy unrealistic expectations.”