ORLANDO, FL (UroToday.com) - Most of the abstracts suggested that robotic surgery is as effective as open or laparoscopic surgery regarding oncological and functional outcomes. Casey et.al., suggested that a laparoscopic cystectomy was more cost effective than open cystectomy, in part due to not needing the patient to stay in the ICU after robotic cystectomy.
There were mixed reports on complications after robotic surgery. One group reported that there was a lower transfusion rate, less pulmonary emboli and less incontinence after robotic prostatectomy compared to open. The Mayo clinic found an increased risk of complications and urinary extravasation after robotic surgery, but this may be related to the learning curve.
There is no difference in surgical margin status and the Cornell group reported a 9% positive margin rate, with 5% in T2 disease. Duke reported a 18% positive margin rate and there was no difference between the resident and mentor after the resident had completed a structured teaching program. There is a suggestion that an intrafascial dissection will lead to a higher positive margin rate and this procedure should be restricted to low risk patients.
Finally, anterior and posterior support of the vesico-urethral anastomosis is associated with improved time to continence.
Presented by Ashutosh Tewari, MD, at the Annual Meeting of the American Urological Association (AUA) - May 17 - 22, 2008. Orange County Convention Center - Orlando, Florida, USA.
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