Robotic Assisted Laparoscopic Radical Prostatectomy (RALRP), commonly called da Vinci System isn’t a recent entrant to the cancer treatment realm. It was first introduced in 1997 to assist in cardiac surgery. And the first robotics assisted surgery using the da Vinci system was performed in 1998. Later on, FDA clearance for using the RALRP method was obtained in 2001. Since then, the system became very effective and has been widely adopted not just within the urological community but within other specialties as well.
More than 400,000 surgeries were performed using the multi armed da Vinci in 2012. The figures were at 73,000 in 2009 and less than 5,000 in 2002. Things have come to such a state that patients today interview their surgeons if they use robotics in surgery. If the answer is no, they move on to the next urologist who offers robo-assisted surgery. But not everyone shares this enthusiasm about the multi-million dollar da Vinci system.
There’s also been a lot of negative publicity surrounding robotics in surgery. An article on The New York Times reports ‘freak accidents’ wherein the robotic arm slapped a woman in the face while she lay at the operating table or an incident where the robot didn’t let go a tissue that was held during surgery. High operative costs also deter this system from being adapted as a conventional treatment method.
Some of the commonly perceived advantages and disadvantages associated with using robotics in surgery include;
a) Less invasive: The system is designed to be minimally invasive so that surgeons can operate with just a few small incisions. It offers the surgeon a 3D stereo vision that not only allows him to manipulate surgical instruments within a patient’s body with dexterity, but also reach places impossible to reach with bare hands.
b) Fewer in-hospital complications: A study of outcome amongst Medicare patients suggested that surgeries performed with the help of da Vinci had fewer instances of in-hospital complications. A 2007 review found that robotic surgery was equally effective in prostate cancer treatment when compared to other types of surgery including laparoscopic prostate surgery or radical prostatectomy. But patients who underwent robotic surgery experienced fewer instances of bleeding and scarring.
c) Technology continues to evolve: The da Vinci system that you see today was evolved from several prototypes each of which aimed to combine the benefits of open surgery and the laparoscopic approach. There are several instruments available for the robot.
a) Cost: Naturally, the cost for treatment would be higher than conventional options, but because of the skills of the surgeon, can be nominal.
b) Other possible solutions aren’t explored: Surgery isn’t always the only option left for a patient diagnosed with prostate cancer. Some of the other alternatives include radiation and hormone therapies. It may happen that sometimes possibilities for non surgical treatment aren’t explored as they were earlier.
A lot has to do with the experience and skill of the surgeon. In the hands of an experienced and skilled surgeon, robotic surgeries have reported fewer problems and better recovery.
Robotic Assisted Laparoscopic Radical Prostatectomy is the most effective and widely used robotics in surgery adopted by urological community. To create awareness of this surgery, the author of this article elucidates both the advantages and disadvantages of RALRP.