MARCH OF THE ROBOSURGEON

WHEN making a decision about undergoing prostate cancer surgery, should you entrust yourself to a skilful surgeon alone or choose a surgeon working with the assistance of a Da Vinci robot?

The suggestion is that robotic surgery is safer, with fewer side-effects. However, the charity Prostate Cancer UK believes there is not yet enough good evidence to show it’s significantly more beneficial than conventional keyhole surgery.

A major review of studies published last year by the authoritative Cochrane organisation found no significant difference in long-term outcomes, including risk of dying from prostate cancer or preventing the cancer coming back, between the three main types of surgery — open surgery, keyhole and robot-assisted prostatectomy.

‘While long-term outcomes may be similar, studies show that keyhole surgery and robotic prostatectomy both result in less bleeding and scarring and a shorter hospital stay,’ says Laura James, a senior specialist nurse at Prostate Cancer UK.

Men who undergo robotic prostatectomy are also likely to recover slightly faster than with keyhole surgery, and these men regain urinary and erectile function more quickly; however, operating times can be longer with robotic surgery, she adds.

And while robot-assisted prostatectomy is widely available, it is still not offered at all NHS cancer hospitals in the UK because of the expense of acquiring the Da Vinci, which costs around £1.5 million to buy and £100,000 a year to run.

Professor Chris Eden, a consultant urological surgeon based at the Royal Surrey County Hospital, who performs both keyhole and robotic prostatectomy, says that cost implications should be considered when NHS budgets are so tight.

‘In my opinion, it makes more sense to spend time, money and effort in training surgeons in the infinitely more flexible laparascopic [keyhole] surgery, which can be done using equipment found in most operating theatres rather than sinking it into a very expensive surgical instrument.’