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

Declan G. Murphy, Anders Bjartell, Vincenzo Ficarra, Markus Graefen, Alexander Haese, Rodolfo Montironi, Francesco Montorsi, Judd W. Moul, Giacomo Novara, Guido Sauter, Tullio Sulser, Henk van der Poel

Research output: Contribution to journalArticle

98 Citations (Scopus)

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 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.

Original languageEnglish
Pages (from-to)735-746
Number of pages12
JournalEuropean Urology
Volume57
Issue number5
DOIs
Publication statusPublished - May 2010

Fingerprint

Prostatectomy
Learning Curve
Robotics
Prostatic Neoplasms
Equipment Failure
Technology
Operative Time
Prostate
Language
Economics
Outcome Assessment (Health Care)
Safety

Keywords

  • Complications
  • Continence
  • da Vinci
  • Erectile function
  • Laparoscopic
  • Prostate cancer
  • Radical prostatectomy
  • Robotic

ASJC Scopus subject areas

  • Urology

Cite this

Murphy, D. G., Bjartell, A., Ficarra, V., Graefen, M., Haese, A., Montironi, R., ... van der Poel, H. (2010). Downsides of Robot-assisted Laparoscopic Radical Prostatectomy: Limitations and Complications. European Urology, 57(5), 735-746. https://doi.org/10.1016/j.eururo.2009.12.021

Downsides of Robot-assisted Laparoscopic Radical Prostatectomy : Limitations and Complications. / Murphy, Declan G.; Bjartell, Anders; Ficarra, Vincenzo; Graefen, Markus; Haese, Alexander; Montironi, Rodolfo; Montorsi, Francesco; Moul, Judd W.; Novara, Giacomo; Sauter, Guido; Sulser, Tullio; van der Poel, Henk.

In: European Urology, Vol. 57, No. 5, 05.2010, p. 735-746.

Research output: Contribution to journalArticle

Murphy, DG, Bjartell, A, Ficarra, V, Graefen, M, Haese, A, Montironi, R, Montorsi, F, Moul, JW, Novara, G, Sauter, G, Sulser, T & van der Poel, H 2010, 'Downsides of Robot-assisted Laparoscopic Radical Prostatectomy: Limitations and Complications', European Urology, vol. 57, no. 5, pp. 735-746. https://doi.org/10.1016/j.eururo.2009.12.021
Murphy, Declan G. ; Bjartell, Anders ; Ficarra, Vincenzo ; Graefen, Markus ; Haese, Alexander ; Montironi, Rodolfo ; Montorsi, Francesco ; Moul, Judd W. ; Novara, Giacomo ; Sauter, Guido ; Sulser, Tullio ; van der Poel, Henk. / Downsides of Robot-assisted Laparoscopic Radical Prostatectomy : Limitations and Complications. In: European Urology. 2010 ; Vol. 57, No. 5. pp. 735-746.
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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 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.",
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