Robotic and open surgeries achieve similar results

Attempting to allay the apprehensions about robotic surgeries, a first randomised controlled trial that directly compared robotic surgery with open surgery for patients with localised prostate cancer found that robotic and open surgery achieve similar results in terms of key quality of life indicators at three months.

From the time it was first reported in the year 2000, use of robot-assisted laparoscopic prostatectomy (RALP) has been rapidly adopted for men with prostate cancer. Significantly, one million men are diagnosed with prostate cancer worldwide each year. The most common treatment for localised disease is surgery to remove the prostate gland. Some men experience urinary and erectile problems following surgery. For most men, the operation will get rid of the cancer cells, but for around one in three men, cancer cells may return some time after the operation.

Doctors in India vouch for the new technology. “Robotic surgery is the best where repairing is involved. This a more advanced kind of surgery. For complex surgeries, robots work the best.

The best part is that there is not much of a blood loss in robotic surgeries. While in conventional surgery there is an average blood loss of one litre, in robotic surgeries it is less than 100 ml, which is a big advantage,” said Dr Ajay Sharma, senior consultant and chairperson of urology department in Sir Ganga Ram hospital.

In India, doctors have been conducting robotic surgeries for the last five years in prostate cancer cases. Dr Sharma says so far about 1,000 such surgeries have been conducted in India.

The only problem Dr Sharma says is the higher cost of the surgery.

“The instruments used in robotic surgeries are very expensive. There is only one US-based company that makes robots and they are too expensive.”

While an open surgery would cost Rs 2,00,000 including hospitalisation, the cost goes upto Rs 3.5 lakh in case of robotic surgery.

In the study, many clinicians also claimed the benefits of robotic technology lead to improved quality of life and oncological outcomes. “Our randomised trial, the first of its kind, found no statistical difference in quality of life outcomes between the two groups at 12 weeks follow-up. Patients are now being followed-up for a total of 2 years in order to fully assess the longer-term outcomes, including on cancer survival” says lead author professor Robert “Frank” Gardiner, University of Queensland Centre for Clinical Research, Brisbane, Australia.

During their study, 308 men with prostate cancer were included and were randomly assigned to either receive robot-assisted surgery (157) or open surgery (radical retropubic prostatectomy) (151).

The primary outcomes included urinary and sexual function at 12 weeks and there was no difference in between the two groups. Experts also found that there were no differences in the number of post-operative complications. Patients who underwent open surgery spent a longer amount of time in hospital after surgery but on average, both groups spent the same number of days away from work.

Patients who underwent open surgery lost on average three times more blood. However, patients who underwent robotic surgery experienced less pain doing day to day activities (at 1 week), and reported better overall physical quality of life (at 6 weeks).