Length of stay and blood loss were reduced with robotic-assisted radical prostatectomy (RARP) compared with open radical prostatectomy in obese men with prostate cancer who underwent surgery for their disease.1
Prostate cancer is the most common solid organ malignancy in men in the United States; 1 in 6 men will develop the disease during their lifetime. Frequently chosen treatment options is radical prostatectomy, which involves removing some surrounding tissue as well as the prostate gland, is performed either as robotic-assisted or as an open procedure.
The robotic system allows surgeons to operate through a few small incisions. The system translates the movements of the surgeon’s hand or wrist into highly precise movements of the surgical instruments. The surgeon directs every maneuver in real time while viewing a magnified, 3-dimensional, high-definition image of the surgical site.
Almost 40% of adults in the United States are obese, according to background information in the article. Obesity often comes with comorbidities that make operations challenging, such as diabetes, heart disease, and obstructive sleep apnea.
The researchers identified 9108 obese men who underwent radical prostatectomy; 60.4% of whom underwent RARP, and 39.6% underwent open prostatectomy. The study was led by Gopal Gupta, MD, an assistant professor in the Department of Urology of Loyola University Chicago Stritch School of Medicine, Chicago, Illinois.
Compared with patients who underwent open prostatectomy, the patients who underwent RARP were 83% less likely to require blood transfusions and 72% less likely to require prolonged hospital stays. Risk of infections and other complications, however, were not reduced by the robotic-assisted surgery.
Given that the complication rates are similar between the robotic and open surgery options, the implication for urologists is that both techniques remain interchangeable. The approach chosen should be dictated by the surgeon’s comfort level.
For obese patients with prostate cancer, the findings suggest that both approaches to the surgery are feasible and safe.
1. Ellimoottil C, Roghmann F, Blackwell R, et al. Open versus robotic radical prostatectomy in obese men. Curr Urol. 2015;8(3):156-161.