Robotic assisted radical prostatectomy: a different treatment for prostate cancer?

Abstract

Considering the Health Care System in Brazil, a developing country, and public healthcare policies, robotic surgery is a reality to very few citizens. Therefore, robotic assisted radical prostatectomy is far removed from the daily practice of the vast majority of Brazilian urologists. Scientific evidence of the superiority of robotic assisted radical prostatectomy does not presently justify public investments for widespread development of robotic centers. Maybe over time and with reductions in costs, robotic technology will become a more established practice, as observed in other countries, and more feasible for the Brazilian urological community.

Challenges and opportunities in prostate cancer surgery in South America: Insights into robot‐assisted radical prostatectomies—A perspective

“…Recent years have witnessed the rise of robot‐assisted radical prostatectomies (RARPs), which have shown superior outcomes, including less blood loss, lower transfusion rates, and fewer positive surgical margins post‐resection compared to open radical prostatectomies 5 . Other reported benefits of this approach include smaller surgical incisions, reduced analgesic requirements, shorter hospital stays, and improved functional outcomes such as erectile function and urinary continence recovery 6,7 . A general consensus among urologists suggests that the use of robotic systems permits a significant degree of magnification and provides better ergonomics for the surgeon by eliminating the need for intricate wrist movements (as is required for complicated laparoscopic prostatectomies) and nullifying the effect of tremors 6 …”

“…Given the existing economic disparities and the limited potential for significant improvements in either the economic status of individuals or a more equitable distribution of resources, it is improbable that a substantial proportion of the population will have the financial means to afford these costly healthcare procedures. Moreover, the lack of substantial scientific evidence supporting the widespread establishment of robotic centers currently does not justify significant public investments in this domain 6 . Consequently, expanding access to robot‐assisted prostatectomies in South America poses an additional challenge.…”

“…Neumaier et al conducted a study highlighting the potential incompleteness of data collected from medical and hospital records regarding the outcomes of robot‐assisted prostatectomies, which may result in an underestimation of complications and an inadvertent overestimation of positive results 19 . Considering the economic disparities and divergent public policies within South American countries, access to robot‐assisted surgeries remains constrained, limiting the number of citizens who can benefit from these procedures 6 . Given the existing economic disparities and the limited potential for significant improvements in either the economic status of individuals or a more equitable distribution of resources, it is improbable that a substantial proportion of the population will have the financial means to afford these costly healthcare procedures.…”

Untitled

“…Nem mesmo, como mencionado acima, a prostatectomia é um consenso na literatura, visto que os investimentos iniciais para ela são de US$ 1,8 milhão, com uma taxa de manutenção de US$ 100.000/ano, e alguns autores afirmam a inviabilidade desse procedimento para o Sistema Único de Saúde -SUS (Julio et al, 2010).…”

“…Os desfechos baseados em análises econômicas completas questionam o custo-efetividade dos procedimentos para câncer de próstata, apesar da relevante melhora nas taxas de morbidade, de grande impacto na qualidade de vida, como incontinência urinária e disfunção erétil (Du et al, 2018;Julio et al, 2010;Schroeck et al, 2017).…”