In an editorial in Eur Urol (2014), the concluding statement sums up the advantages of Robotic surgery.
“Robotics is like driving a limousine instead of a compact car. you can go the same distance in both, but the limousine, although more expensive, is safer, smoother, and more comfortable.”
In an article by Eylert et al published in JCU (2014) the authors report a continuous fall in the incidence of bladder cancer (not including early pTa disease or carcinoma-in-situ. They looked at National Cancer Data Repository data for years 1990-2009. Overall the incidence of bladder cancer fell from 10,742 to 8,775 during this time period. Mortality has also fallen (from 4546 to 4135) but not proportionately, suggesting poorer survival.
In an article published by Porpiglia et al in Eur Urol, the authors studied outcomes in a group of men randomised to either laparoscopic or robotic prostatectomy. Surgery was carried out by a single surgeon with large experience of both approaches. Robotic surgery was associated with better continence at various time points up to 12 months, better erectile function and similar margin rates.
Both laparoscopic and robotic radical prostatectomies have undoubted advantages over the open approach, but there is continued debate whether the extra cost of robotic surgery can be justified compared to laparoscopic surgery. This study, although small and easily criticised for being the experience of a single surgeon will add to the debate.
There is a lack of high quality evidence to help decision making whilst choosing treatment for localised prostate cancer. In a study by Sooriakumaran et al published in BMJ (2014) the authors study 34515 Swedish men treated for prostate cancer with either surgery (n=21533) or radiotherapy (n=12982). Median follow up was over 5 years for both modalities. Mortality from prostate cancer was higher in the radiotherapy arm for patients with non-metastatic disease (subdistribution hazards ratio=1.76). Younger, fitter men with fewer comorbitities and with intermediate or high risk disease had the greatest differential benefit from surgery.
There are a number of limitations of this study, and a randomised trial comparing these two treatments is still awaited, but this probably gives the best current evidence.