Evolution Of Open Radical Retropubic Prostatectomy--how Have Open Surgeons Responded To The Challenge Of Minimally Invasive Surgery?

UroToday.com – Over the past seven to eight years there has been a proliferation of minimally invasive surgery (MIS) techniques for the treatment of urologic malignancies. This is no better demonstrated than the radical prostatectomy procedure for patients with prostate cancer. These clinical researchers undertook a unique survey study to assess the influence of MIS on open surgeons with regards to technique, surgical equipment, and perioperative management of patients undergoing surgery for urologic malignancies. This survey was submitted to all members of the Society of Urologic Oncology and assessed the open surgeons’ sense of competition from MIS.

Interestingly, one quarter of surgeons noted reduced radical retropubic prostatectomy (RRP) case volumes because of MIS competition, and over 30% had started to perform MIS RRP. An additional 25% of the surgeons were doing mostly or exclusively MIS for this procedure. In addition, MIS had influenced over 50% of open surgeons to reduce their incision length for RRP, 40% to reduce their operative time and 31% to reduce their blood loss and transfusion rate.

MIS had also influenced open surgeons to use new instruments or loops and to modify their dissection or anastomotic technique and increase the use of hemostatic agents during their surgical procedure. In addition, MIS had encouraged these surgeons to shorten their patients’ length of hospital stay, time to starting regular diet, duration of drain and Foley catheter and time to return to work and exercise following RRP. In addition, MIS has instigated the use of clinical pathways for 14% of the surgeons and use of validated questionnaires for postoperative follow-up in 22% of the surgical practices.

While not all open surgeons have embraced the minimally invasive surgical techniques for management of their urologic malignancy patients, this shift in operative approach has had a significant influence on the open surgeons to modify their open surgical technique and thereby reduce their patient convalescence and follow-up recommendations. It will be of interest to see over the next decade where the trend in practice patterns gravitates with regards to open surgery versus minimally invasive surgery for patients undergoing radical prostatectomy.

Acharya SS, Zorn KC, Shikanov S, Thong A, Zagaja GP, Shalhav AL, Steinberg GD
J Endourol. 2009 Nov;23(11):1893-7
10.1089/end.2008.0509

Written by UroToday.com
Contributing Editor Elspeth M. McDougall, MD, FRCSC, MHPE