A selected review and personal experience with robotic prostatectomy: implications for adoption of this new technology in the United Kingdom

Abstract

Robot-assisted laparoscopic prostatectomy (RALP) is a rapidly evolving technique for the treatment of localized prostate cancer. However, cynics point to the increasing role of market forces in the robotic revolution. As yet, Europe has not taken up RALP in large numbers and this may in part relate to the high level of expertise in laparoscopy previously gained. Furthermore, setting up a robotic programme is a major undertaking for many surgical units. This review discusses some of the challenges in the development of a robotic service drawn from personal experience within the United Kingdom. Furthermore, available data on RALP versus open and laparoscopic approaches are reviewed for surgical and cancer-related outcomes. Preliminary data appear to show an advantage over open prostatectomy with reduced blood loss, decreased pain and early mobilisation and shorter hospital stay. Most intra-institutional studies demonstrate better postoperative continence and potency with RALP; however, this needs to be viewed in the context of a paucity of randomized data available in the literature. There is no definitive data to show an advantage over standard laparoscopic surgery, but the fact that this technique has reached parity with laparoscopy within 5 years is encouraging: with continued experience, the hope is that results will continue to improve.

A realist process evaluation of robot-assisted surgery: integration into routine practice and impacts on communication, collaboration and decision-making

“…Meanwhile, reports of the use of RAS highlight that there is a learning curve for the whole team 112 and point to the need for a highly motivated 113 and/or dedicated robotic team. [114][115][116] This suggests that when the OT team is experienced in RAS and members are motivated, RAS is more likely to become embedded into surgical practice.…”

“…Other contextual factors described were the level of motivation 154 and stability of the team. 113 Thus, a team that is not motivated may work through the robot-assisted operations but not engage with them as an opportunity to learn and, consequently, the increased experience of RAS may not translate into increased efficiency in robot set-up.…”

Embedding robotic surgery into routine practice and impacts on communication and decision making: a review of the experience of surgical teams

“…While typically discussed in relation to the surgeon's learning curve (Whiteside 2008), the theory suggests the number and frequency of robotic operations that take place within the organisation is a contextual factor that impacts on the effectiveness of this strategy. Other contextual factors are level of motivation (Payne and Pitter 2011) and stability of the team (Goldstraw et al 2007). Thus, a team which is not motivated may work through the robotic operations but not engage with them as an opportunity to learn and consequently increased experience of robotic surgery may not translate into increased efficiency in robot set-up.…”

Overcoming the challenges of robot-assisted radical prostatectomy

“…Following this, most surgeons agree that a stepwise progression from case observation to primary assistant followed by structured console work appears to make for the smoothest transition, however, there is no consensus on the number of observed cases necessary before progressing. 5 Proctorship is often used to overcome the steepest part of the LC, however, with no governing body to assess and approve these surgical experts, proctors can be a fairly heterogeneous pool. 3 Intuitive Surgical recognises any robotic surgeon who has completed 20 robotic cases as a potential proctor.…”