07 January 2010

Proliferation of minimally invasive surgery vs open radical prostatectomy

Over the past seven to eight years there has been noted a proliferation of minimally invasive surgery (MIS) techniques for the treatment of urologic malignancies. This evolution is no better demonstrated than the radical prostatectomy surgery
A research team at Berkeley University, CA, US, undertook a unique survey study to assess the influence of minimally invasive surgery 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. It is very interesting that one quarter of surgeons noted reduced radical retropubic prostatectomy (RRP) case volumes because of MIS competition, and over 30% surgeons had started to perform minimally invasive surgery radical retropubic prostatectomy.

In addition:
  • 25% of the surgeons were doing mostly or exclusively MIS for this procedure,
  • 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 devices and to change their dissection or anastomotic technique and increase the use of hemostatic agents during their surgical procedure.
  • MIS had encouraged these surgeons to shorten their patients' stay in hospital, time to starting regular diet, duration of drain and Foley catheter and time to recover and return to work and exercise following RRP;
  • 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 accepted the minimally invasive surgical techniques for management of their urologic malignancy patients, this shift in operative approach has had an important influence on the open surgeons to change their open surgical technique and thereby reduce the patient recover, convalescence and follow-up recommendations. For patients undergoing radical prostatectomy, it will be of big interest to review over the next decade where the trend in practice patterns gravitates with regards to open surgery versus minimally invasive surgery.



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