Robotic Surgery Hits the Headlines

Robotic prostate surgery hit the news on 27th July, after the Lancet Journal published the results of an Australian study comparing robotic surgery with traditional open surgery for prostate cancer.

The Brisbane study demonstrated equivalent outcomes for cancer clearance, incontinence and sexual function, with less blood loss and shorter hospital stay favouring the robotic approach.

Many newspapers misinterpreted this, one claiming ‘expensive robotic surgery for prostate cancer is not worth it’, while others, notably The Telegraph claimed ‘robots as good as human surgeons’.
Hailed as an important study comparing the two approaches head to head for the first time, the study design has been criticised by surgeons across the world and even labelled as fallacious.

The study compared two individual surgeons with vastly differing experience. The open surgeon had completed 1500 cases over 15 years before the study, compared to only 200 cases over two years for the robotic surgeon.

It is well recognised that outcomes from surgery, as with any profession/pastime demanding physical skill or dexterity, are heavily influenced by prior experience and regular practise. The success of every pro golfer, sculptor, ballet dancer or master craftsman is a testament to this. The ‘learning curve’ of gradually improving results for surgical procedures has been well studied and is dependent on case volume, independent of technique used.

Many robotic surgeons have argued that what the study really shows is that using a robot enables a surgeon to achieve high-quality results many years and many hundreds of patients before he/she ever would have done with open surgery, thus proving its value.

The debate on this study may run and run amongst surgeons, but several facts are not disputed:

  • no open surgeon who moved to robotic surgery has ever gone back
  • every year the proportion of cases undertaken in the UK using robotic surgery rises
  • choosing a high volume surgical team is critical in getting the very best outcome for prostate cancer surgery.
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