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AUA 2018

AUA 2018: The Changing Face of Urologic Oncologic Surgery from 2000-2018 - Impact of Robotics

San Francisco, CA (UroToday.com) In this late-breaking session, Inderbir Gill, MD gave a brief history of robotics, stating that major urologic oncologic surgery had traditionally been performed open with robotics introduced in the late 1990s.  His group performed a large meta-analysis seeking to answer five key questions comparing open to robotics:

  1. Penetrance in the field
  2. Peri-operative outcomes
  3. Oncologic outcomes and survival
  4. Functional outcomes
  5. Financial costs
In 2005, utilizing the premiere database, approximately 70% of prostate, kidney, and bladder cancer surgeries were performed open compared to 30% robotic.  In 2017 this reversed with 31% open and 69% robotic.  Subtyped by surgical case, 66% of partial nephrectomies and 85% of radical prostatectomy were performed robotically in 2017.  Only 24% of radical nephrectomy and 33% of radical cystectomy were performed with the robot. 

181 publications were utilized in statistical analysis with over 63,000 patients generating 2,000 forest plots for radical prostatectomy, radical cystectomy, and partial nephrectomy.  Operative time favored the open technique for all of these operations.  Robotic techniques had less blood loss, transfusion rates, length of stay, readmission rates, and complications (major vs minor and early vs late). A reverse sensitivity analysis holding for PSA and pathologic T stage for patients undergoing radical prostatectomy demonstrated equal positive margin and recurrence rates, but improved lymph node yield.

Temporally, since 2010, positive margin rate, continence and potency has all improve statistically significantly for radical prostatectomy.  Regarding robotic radical cystectomy, the cut off was 2011, with lymph node yield, early and late post-operative complications with statistically significant improvements compared to open.  Studying proficiency, 20 cases was the marker for radical cystectomy with improvements in length of stay and overall positive margins.  Financially, robotic cases were more expensive in the operating room. 

This study is limited by sub-optimal level of evidence but continues to fuel the debate between open and robotic techniques. 


Presented by: Inderbir Gill, MD, MCh Keck School of Medicine, University of Southern California, Los Angeles, CA

Written by:  David B. Cahn, DO, MBS Fox Chase Cancer Center Philadelphia, PA @dbcahn at the 2018 AUA Annual Meeting - May 18 - 21, 2018 – San Francisco, CA USA