DANVILLE -- Four years after beginning its robotic prostatectomy approach, Geisinger Medical Center has seen a dramatic climb in the number of patients benefiting from the innovative surgery over conventional laparoscopy and traditional open surgery.
And despite a recent study reporting mixed results in long-term benefits of both laparoscopic procedures, Geisinger surgeons say that hasn't been the case with their patients, most of whom are now being helped by the $1.8 million da Vinci Surgical System.
The Journal of Clinical Oncology recently published a study of 2,702 Medicare patients who underwent radical prostatectomy between 2002 and 2005 indicating fewer complications and quicker recoveries in comparison to open surgery. The study also reported an increased chance for longer term problems that require further therapy, such as a greater risk of (internal) scarring and a need for hormonal or drug therapy six months after surgery.
Dr. Dan Rukstalis, Geisinger's director of urology, says those set backs have not been a factor in local outcomes.
"That's not what we're finding," Dr. Rukstalis said. "Our patient population report of cancer-related results in robot procedures appears to be the same in the open surgery (population). We're also seeing the same benefits as reported in the study, where robot patients are experiencing less bleeding, less scarring, and shorter recoveries."
Since launching the robotic system, Geisinger has seen its portion of prostatectomies shift from 80 percent done by open surgery to 95 percent now done by the robotic system. In 2004, Geisinger performed approximately 100 robotic laparoscopies, equating to roughly five percent all prostate cancer surgeries. Today, between 150 to 200 robotic laparoscopies are done each year, Dr. Rukstalis said.
"The trouble with this study is it's comparing open surgery, which was established fifty years ago in the hands of very accomplished surgeons, to laparoscopic surgery, which is fairly new in the hands of less experienced surgeons," Dr. Rukstalis said. "The people who were doing the open surgery had already been doing it for twenty years. People doing laparoscopic surgery had only been doing it for at most five years."
Dr. Rukstalis said it's difficult to compare a new treatment with an established approach, particularly when a lot of the success in outcomes is relative to the experience of the surgeon.
In the meantime, Dr. Rukstalis said the robotic laparoscopic procedure is here to stay, because it provides a lot of benefit to the patient and surgeon.
"The robot's hands can maneuver all the same degrees as a surgeon's hand," Dr. Rukstalis said. "Surgical maneuvers that require special dexterity can be done well with a robot but not in a laparoscopic procedure. The robot system also sees in three-dimension. Without it, it's almost like walking through life with one eye closed."
The added dimension enables surgeons to be more efficient with the surgery, according to Dr. Rukstalis.
"By seeing in three dimensions, depth of field is clearer, relationship of one tissue to another tissue is clearer," Dr. Rukstalis said. "It allows (surgeons) to move faster and make better decisions."
Dr. Rukstalis said the robotic procedure has migrated to a number of other cancer surgeries at Geisinger, including kidneys, bladder, and in pediatric cancer cases. Any procedure that requires specific suturing or reconstruction, the robot is a good tool, Dr. Rukstalis said.
"New technology isn't enough," Dr. Rukstalis said. "You have to have experienced surgeons but having experienced surgeons aren't enough anymore. It's really the combination of the two that gets the best results.
"We've been lucky here at Geisinger to have the financial ability to invest in new technology and understand the importance to train people and build experience."
Life
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Robert Inglis
For some surgeries ... Robots are taking over
Beneficial results for Geisinger patients buck recent study
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