Robotic & minimally invasive surgery

Overview

• Prostate cancer: NICE NG131 (1.3.17) says commissioners of urology services should consider providing robotic surgery for localised prostate cancer, and (1.3.18) that robotic systems should be based in centres expected to perform at least 150 robot-assisted laparoscopic radical prostatectomies a year to be cost effective, which is a fair thing to ask a unit about.
• What it costs in continence, from the trial: in ProtecT, absorbent pad use rose from 1 percent before treatment to 46 percent at 6 months after prostatectomy, against 4 percent on active monitoring and 5 percent after radiotherapy; by year 6 it was 17 percent, 8 percent and 4 percent. Over years 7 to 12, leakage requiring pads affected 18 to 24 percent of the prostatectomy group against 9 to 11 percent on monitoring and 3 to 8 percent after radiotherapy.
• What it costs in sexual function: 67 percent of men in ProtecT reported erections firm enough for intercourse before treatment; at 6 months this was 12 percent in the prostatectomy group, 22 percent after radiotherapy and 52 percent on monitoring. Surgery recovered to 21 percent at 36 months and fell again to 17 percent at 6 years. At 7 years, 18 percent of the prostatectomy group reported erections sufficient for intercourse against 30 percent on monitoring and 27 percent after radiotherapy, and all three converged to low levels by year 12.