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Downsides of Robot-assisted Laparoscopic Radical Prostatectomy: Limitations and Complications

Murphy, Declan G.; Bjartell, Anders LU ; Ficarra, Vincenzo; Graefen, Markus; Haese, Alexander; Montironi, Rodolfo; Montorsi, Francesco; Moul, Judd W.; Novara, Giacomo and Sauter, Guido, et al. (2010) In European Urology 57(5). p.735-746
Abstract
Context: Robot-assisted laparoscopic radical prostatectomy (RALP) using the da Vinci Surgical System (Intuitive Surgical, Sunnyvale, CA, USA) is now in widespread use for the management of localised prostate cancer (PCa). Many reports of the safety and efficacy of this procedure have been published. However, there are few specific reports of the limitations and complications of RALP. Objective: The primary purpose of this review is to ascertain the downsides of RALP by focusing on complications and limitations of this approach. Evidence acquisition: A Medline search of the English-language literature was performed to identify all papers published since 2001 relating to RALP. Papers providing data on technical failures, complications,... (More)
Context: Robot-assisted laparoscopic radical prostatectomy (RALP) using the da Vinci Surgical System (Intuitive Surgical, Sunnyvale, CA, USA) is now in widespread use for the management of localised prostate cancer (PCa). Many reports of the safety and efficacy of this procedure have been published. However, there are few specific reports of the limitations and complications of RALP. Objective: The primary purpose of this review is to ascertain the downsides of RALP by focusing on complications and limitations of this approach. Evidence acquisition: A Medline search of the English-language literature was performed to identify all papers published since 2001 relating to RALP. Papers providing data on technical failures, complications, learning curve, or other downsides of RALP were considered. Of 412 papers identified, 68 were selected for review based on their relevance to the objective of this paper. Evidence synthesis: RALP has the following principal downsides: (1) device failure occurs in 0.2-0.4% of cases; (2) assessment of functional outcome is unsatisfactory because of nonstandardised assessment techniques; (3) overall complication rates of RALP are low, although higher rates are noted when complications are reported using a standardised system; (4) long-term oncologic data and data on high-risk PCa are limited; (5) a steep learning curve exists, and although acceptable operative times can be achieved in <20 cases, positive surgical margin (PSM) rates may require experience with >80 cases before a plateau is achieved; (6) robotic assistance does not reduce the difficulty associated with obese patients and those with large prostates, middle lobes, or previous surgery, in whom outcomes are less satisfactory than in patients without such factors; (7) economic barriers prevent uniform dissemination of robotic technology. Conclusions: Many of the downsides of RALP identified in this paper can be addressed with longer-term data and more widespread adoption of standardised reporting measures. The significant learning curve should not be understated, and the expense of this technology continues to restrict access for many patients. (C) 2009 European Association of Urology. Published by Elsevier B. V. All rights reserved. (Less)
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keywords
Radical prostatectomy, Prostate cancer, Laparoscopic, Erectile function, Continence, da Vinci, Complications, Robotic
in
European Urology
volume
57
issue
5
pages
735 - 746
publisher
Elsevier
external identifiers
  • wos:000275739600001
  • scopus:77949487015
ISSN
1873-7560
DOI
10.1016/j.eururo.2009.12.021
language
English
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yes
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8d749db6-8247-4275-89ef-57781a2542ba (old id 1588042)
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2010-04-22 11:11:06
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2018-06-17 04:27:56
@article{8d749db6-8247-4275-89ef-57781a2542ba,
  abstract     = {Context: Robot-assisted laparoscopic radical prostatectomy (RALP) using the da Vinci Surgical System (Intuitive Surgical, Sunnyvale, CA, USA) is now in widespread use for the management of localised prostate cancer (PCa). Many reports of the safety and efficacy of this procedure have been published. However, there are few specific reports of the limitations and complications of RALP. Objective: The primary purpose of this review is to ascertain the downsides of RALP by focusing on complications and limitations of this approach. Evidence acquisition: A Medline search of the English-language literature was performed to identify all papers published since 2001 relating to RALP. Papers providing data on technical failures, complications, learning curve, or other downsides of RALP were considered. Of 412 papers identified, 68 were selected for review based on their relevance to the objective of this paper. Evidence synthesis: RALP has the following principal downsides: (1) device failure occurs in 0.2-0.4% of cases; (2) assessment of functional outcome is unsatisfactory because of nonstandardised assessment techniques; (3) overall complication rates of RALP are low, although higher rates are noted when complications are reported using a standardised system; (4) long-term oncologic data and data on high-risk PCa are limited; (5) a steep learning curve exists, and although acceptable operative times can be achieved in &lt;20 cases, positive surgical margin (PSM) rates may require experience with &gt;80 cases before a plateau is achieved; (6) robotic assistance does not reduce the difficulty associated with obese patients and those with large prostates, middle lobes, or previous surgery, in whom outcomes are less satisfactory than in patients without such factors; (7) economic barriers prevent uniform dissemination of robotic technology. Conclusions: Many of the downsides of RALP identified in this paper can be addressed with longer-term data and more widespread adoption of standardised reporting measures. The significant learning curve should not be understated, and the expense of this technology continues to restrict access for many patients. (C) 2009 European Association of Urology. Published by Elsevier B. V. All rights reserved.},
  author       = {Murphy, Declan G. and Bjartell, Anders and Ficarra, Vincenzo and Graefen, Markus and Haese, Alexander and Montironi, Rodolfo and Montorsi, Francesco and Moul, Judd W. and Novara, Giacomo and Sauter, Guido and Sulser, Tullio and van der Poel, Henk},
  issn         = {1873-7560},
  keyword      = {Radical prostatectomy,Prostate cancer,Laparoscopic,Erectile function,Continence,da Vinci,Complications,Robotic},
  language     = {eng},
  number       = {5},
  pages        = {735--746},
  publisher    = {Elsevier},
  series       = {European Urology},
  title        = {Downsides of Robot-assisted Laparoscopic Radical Prostatectomy: Limitations and Complications},
  url          = {http://dx.doi.org/10.1016/j.eururo.2009.12.021},
  volume       = {57},
  year         = {2010},
}