Robotic Surgical System for Radical Prostatectomy: A Health Technology Assessment

Prostate cancer is the second most common cancer in men in Canada. It forms in the prostate gland of the male reproductive system and often grows very slowly. However, in some patients, prostate cancer grows more quickly and is fatal. 

One of the possible treatments for prostate cancer is to surgically remove the prostate gland. This is known as radical prostatectomy. It can be performed in an open, laparoscopic, or robot-assisted approach. The open approach is the traditional surgical approach and involves a large incision. In contrast, laparoscopic and robot-assisted approaches are minimally invasive and performed through small keyhole incisions. The robot-assisted approach is the newest method. It uses a surgical robotic system with arms that the surgeon controls to perform the radical prostatectomy. 

We reviewed the evidence to evaluate the effectiveness, safety, and cost-effectiveness of the robotic surgical system for radical prostatectomy compared with the open and laparoscopic approaches. 

We did not find high-quality evidence that the robot-assisted approach improves cancer-related outcomes or important functional outcomes (e.g., urinary function and sexual function). The robotic surgical approach does appear to improve some perioperative outcomes, such as the length of the hospital stay and blood loss. 

Patients may prefer the robot-assisted method, particularly if their surgeon recommends it as a better treatment. 

Our economic analysis showed that compared with open radical prostatectomy, the costs of using the robotic system are relatively large while the health benefits are relatively small. Thus, robot-assisted radical prostatectomy does not appear to be cost-effective in Ontario. 

Tags: cancer, robotic surgery
Year: 2017