I just looked at a new published paper that of 5319 radical prostatectomies RP (4036 marginally invasive RP, and 1283 open RP.) Data was compiled from the National Surgical Quality Improvement Program NSQIP database.
Mortality from MIRP was 0.05% and open RP was 0.4%, which was eight times higher.
I haven't seen that paper, but a potential pitfall is to draw conclusions about
fundamental advantage of robotic over
open from results that were gathered across multiple disparate institutions. Better to compare results from the same institution that still does a lot of both.Here
, for instance, is a recent study from Hopkins discussing changes in length-of-stay over the last 20 years that concludes that "RALRP appears to result in a higher proportion of 'off-pathway' [greater than 3 day stay] patients, primarily due to ileus, compared with RRP and LRP"
Robotic requires general anesthesia (which is the source of most of the risk of serious intra- and peri-operative complications) whereas
open RRP can be done under regional anesthesia. Robotic surgery also violates the peritoneal cavity.
Jan '13: PSA 1.23, small nodule on DRE (1st screening @ age 40)
Mar '13: Biopsy 2 of 12 cores GS 3+3: rt mid 10% and rt apex 20% w/ PNI+ Stage cT2a
Apr '13: Biopsy confirmed by Dr. Epstein @ Hopkins
open RRP by Dr. Burnett @ Hopkins. Both nerves spared.
Final Path: GS 3+3, organ confined (tumor extent moderate), SV and 11 nodes all negative (pT2a), negative margins!
PSA: 0.01 @ 6 wks