What are the benefits of robotic surgery over open surgery for urological cancers?

Maurizio Brausi, MD, from the AUSL Modena, B. Ramazzini Hospital, Modena, Italy, discusses the use of robotic surgery for urological cancers at the European Association of Urology (EAU) conference 2017 in London, UK. He describes the joint session with ERUS, the EAU Robotics section, where kidney, bladder and prostate cancer surgery were debated, comparing open surgery with robotic surgery. Prof. Brausi explains that results are good, both with open and robotic surgery. Taking prostate cancer as an example, oncological results do not differ significantly between the different surgical approaches, however robotics is superior when assessing quality of life, erectile dysfunction or continence. Prof. Brausi adds that robotics also gives better results in terms of blood loss and post-operative recovery, with patients able to return home after one day in most cases. However, he points out that costs must also be considered, and that robotic surgery is currently very expensive. Ways to reduce costs include the establishment of platforms at institutions where many different surgeons can work together, including general surgeons, urologists and transplant surgeons, as well as forming high-volume specialized centers for robotic surgery. For muscle invasive bladder cancer, the proportion of robotic surgery is increasing from 4% to 12%. Open surgery is still the standard, but the use of robotics can result in fewer complications, less blood loss and enhanced recovery, with oncological results similar between open and robotic surgery. Prof. Brausi argues that while improvements must still be made, robotics is here to stay. The main consideration is cost. A radical cystectomy requires the patient to stay in the operating room for at least 4 hours with open surgery, and around 6 or 7 hours with robotic surgery. Prof. Brausi points out that being in the surgery position for 7 hours can result in some problems for the patient, and that the length of surgery must be reduced, both from a patient perspective and a cost perspective, as every hour in the operating room costs over €1000.

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