Database Study Shows Shorter Hospital Stay, Fewer Complications for Robotic-Assisted Prostate Surgery Versus Open Surgery
This retrospective study also showed that open prostatectomies performed at multiple hospitals with a robotics program exhibited an overall lower complication rate than open prostatectomies performed at hospitals without a robotics program (15.8 percent versus 17.9 percent, respectively).
The authors indicate that limitations of the study include a lack of cost figures, functional outcomes, pathologic endpoints, and disease-free status, which therefore result in only a partial analysis of comparative effectiveness. In addition, unknown patient selection differences may exist between the open and robotic-assisted groups.
These results were published in the
Surgeons most commonly perform radical prostatectomy to treat prostate cancer in men expected to live for 10 or more years.2 Prostate cancer is the most common cancer in men other than skin cancer, and approximately one man in six will be diagnosed with prostate cancer during his lifetime.3
In this study, researchers used a patient database to identify 71,312 radical prostatectomies performed between 2004 and 2010 by 3,739 surgeons at more than 300 U.S. hospitals, using either open or robotic-assisted techniques. The study found that, compared to open prostatectomy, robotic-assisted radical prostatectomy was associated with a shorter average hospital stay, lower overall complication rate and fewer blood transfusions. These findings are summarized in the table below:
|Open Prostate Surgery (Non-Robotic Hospital)||Open Prostate Surgery (Robotic Hospital)||Robotic-Assisted Prostate Surgery|
|Mean surgery time (hours)||3.2||3.4||4.4|
|Mean length of hospital stay (days)||3.7||3.4||2.2|
|Transfusion rate||17.1% (n=2,360)||11.5% (n=3,449)||2.3% (n=638)|
|Overall complications||17.9% (n=2,474)||15.8% (n=4,759)||10.6% (n=2,892)|
P-values for parameters listed above between each group – robotic-assisted vs. open at robotic hospitals, robotic-assisted vs. open at non-robotic hospitals, and open at robotic vs. non-robotic hospitals – were statistically significant with p < 0.0001.
These results were evident even early in the learning curve.
"The study shows that even in the first 25 cases, robotic-assisted prostatectomies resulted in fewer complications and shorter hospital stays than open surgery," said
The study also found that as surgeons completed more robotic-assisted surgeries, there were decreases in overall surgery time, with less experienced surgeons averaging 5.0 hours for a case and more experienced surgeons averaging 3.9 hours. Decreases in complication rate (from 11.75 percent to 8.95 percent), and conversion rate (from 1.13 percent to 0.18 percent) were also found.
"Our analysis shows that outcomes of robotic-assisted radical prostatectomy improve as surgeons gain more experience with the procedure, and generally can be favorable relative to open surgery," said lead study author
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The da Vinci Surgical System is a surgical platform designed to enable complex surgery using a minimally invasive approach. The da Vinci Surgical System consists of an ergonomic surgeon console or consoles, a patient-side cart with three or four interactive arms, a high-performance vision system and proprietary EndoWrist® instruments. Powered by state-of-the-art technology, the da Vinci Surgical System is designed to scale, filter and seamlessly translate the surgeon's hand movements into more precise movements of the EndoWrist instruments. The net result is an intuitive interface with improved surgical capabilities. By providing surgeons with superior visualization, enhanced dexterity, greater precision and ergonomic comfort, the da Vinci Surgical System makes it possible for skilled surgeons to perform more minimally invasive procedures involving complex dissection or reconstruction. For more information about clinical evidence related to da Vinci Surgery, please visit www.intuitivesurgical.com/company/clinical-evidence/.
This press release contains forward-looking statements within the meaning of the Private Securities Litigation Reform Act of 1995, including statements comparing robotic-assisted prostatectomy procedures to prostatectomy procedures performed by open surgery. These forward-looking statements are necessarily estimates reflecting the best judgment of our management and involve a number of risks and uncertainties that could cause actual results to differ materially from those suggested by the forward-looking statements. These forward-looking statements should, therefore, be considered in light of various important factors, including those under the heading "Risk Factors" in our annual report on Form 10-K for the year ended
1 Davis J, Kreaden U, Gabbert J, Thomas R. Learning Curve Assessment of Robot-Assisted Radical Prostatectomy Compared to Open Surgery Controls from the Premier Perspective Database. J Endourol. 2013 Dec 18. [Epub ahead of print]
2 Medline Plus. Radical Prostatectomy. http://www.nlm.nih.gov/medlineplus/ency/article/007300.htm. Accessed
3 American Cancer Society. What are the key statistics about prostate cancer?
4 Health Information and Quality Authority (HIQA), reporting to the Minister of Health-Ireland. Health technology assessment of robot-assisted surgery in selected surgical procedures,
5 Tewari A, Sooriakumaran P, Bloch DA, Seshadri-Kreaden U, Hebert AE, Wiklund P. Positive surgical margin and perioperative complication rates of primary surgical treatments for prostate cancer: a systematic review and meta-analysis comparing retropubic, laparoscopic, and robotic prostatectomy. Eur Urol. 2012 Jul;62(1):1-15. Epub 2012 Feb 24
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