Robotic-Assisted Laparoscopic Prostatectomy Speeds Recovery

CHAPEL HILL, N.C., Aug. 20 -- A robotic-assisted laparoscopic prostatectomy seems to lead to a faster surgical recovery than an open procedure, found investigators here.

In a study of 162 patients with localized disease, the 42 men who had the robotic-assisted procedure returned to baseline levels of function about 1.3 weeks faster than those who had the open procedure (5.6 weeks versus 6.9 weeks), found Javier Miller, M.D., of the University of North Carolina, and colleagues.

The robotic-assisted patients showed significantly higher improvements in physical quality of life starting in the first week after surgery and extending through week six, compared with those who had open surgery (P<0.0001), the investigators reported in the September issue of the Journal of Urology.

The mental quality of life was not affected by the type of surgical procedure (P=0.133), they added.

However, only half the patients returned the weekly health-related quality of life questionnaires (short form 12) questionnaire completely and accurately.

The mean patient age was 60.6. Pre-op characteristics did not differ significantly between the two groups. The mean estimated blood loss was greater in the open prostatectomy group compared with the robot-assisted men (490 mL versus 232 mL). In addition, more patients in the open prostatectomy group had a blood loss greater than 500 ml (P<0.0001).

The authors pointed out the robotic procedure is costlier than the open surgery, adding approximately ,000 to ,500 per case. "The potential increase in productivity and short term disability savings alone may legitimize the increased cost of the procedure," they wrote.

But in a accompanying editorial comment, Thomas E. Keane, M.D., of the Medical University of South Carolina in Charleston, wrote that he was "unsure that a 1.3 week improvement in return to baseline is all that impressive especially when one considers the cost."

He also stressed that the study had only a 50% patient response rate without explanation and that group sizes were unequal. Moreover, other options such as perineal prostatectomy and laparoscopic prostatectomy were not included in the study.

Study weaknesses also included the mentioned the lack of demographics and comorbidities, said S. Duke Herrell, M.D., of Vanderbilt in Nashville, Tenn., in another accompanying comment.