The article discussed below was originally cited in a post by brainsurgeon. What follows are my impressions from reading the article. It is most definitely not an attempt to provide a full summary or a statistically valid analysis. I was drawn to this article because it summarizes the results of a large number of published papers, but this means that there are many issues with comparing data across papers. In this discussion I focused only on robotic and open surgery. There is also much data on laparoscopic surgery but my impression from this board is that, at least in the U..S., Laparoscopic has largely been replaced by robotic and so I do not discuss it.

What I think I learned.
In this summary I tried to put some numbers to issues which are frequently raised. In particular, I was encouraged by the longer term data on both incontinence and erectile dysfunction. When one looks at data for one year or more post-operation, continence levels seem quite encouraging. The data, although sparse, which suggests that it may take well over a year for erectile function to return is, to me, encouraging.

As a disclaimer, I have no training in medicine. I do have substantial training and experience in statistical data analysis which I hope informs this presentation

Retropubic, Laparoscopic, and Robot-Assisted Radical Prostatectomy: A Systematic Review and Cumulative Analysis Of Comparative Studies
European Urology 55 (2009) 1037–1063

The operation
Average operative time in minutes:
open surgery tends to be faster, 100-130 minutes, than robotic by about 30 minutes but there is some suggestion that experienced robotic surgeons close this gap.

Average blood loss during surgery
Robotic has significantly lower blood loss – about 1/3 that of open, but still only 1/7 of the open patients needed a transfusion

Positive Surgical Margins
For open surgery, the rate of positive surgical margins, subject to fairly wide variation, was about 20%. Robotic surgery showed a somewhat lower rate. For both operations the rate of positive margins was much lower for early stage cancers.

Post operative
Pain, measured by the administration of pain killers.
There is very little data. The one study suggests no difference between open and robotic

Urinary Continence
Generally defined as needing no pad.
Most studies of open show 80%-90% of patients are continent after one year. With less data the continence rates after 6 months for open range from 40% to 80%.
There is little data for robotic but the pattern seems similar to the data for open

Erectile Function
Generally defined as erection sufficient for intercourse
With only two studies the evidence is inconclusive.
One study indicated that 60% to 70% achieve erections sufficient for intercourse within one year regardless of whether they had open or robotic.
A second study showed that the time for half of open patients to achieve intercourse was 700 days while for robotic the number was 340 days.

I hope this is NOT going open the "my surgery choice is better than your choice" again - there is enough bullying in the world.

Choose the best doctor for you - and his/her best method for treating your individual prostate cancer. Every individual is different and results will change from person to person.

My open surgery went smoothly - no blood loss, essentially back to work in two weeks - was able to resume lifting items over 10# after the required 6 weeks - no scarring - no blockage - improving ED and improving incontinence.

Does that make open surgery the better choice - of course not - each person is different and their needs and stats are different.
Thank you for the interesting stats geezer99

BRONSON

If you visit www.henryfordhealth.com and their Vattikuti Urology Institute website, you'll find a chart showing their outcomes concerning Robotic vs. open Prostate Surgery. This chart lists Cancer Removal, Continence @ 6 months, Potency @ 12 months, Safety, Pain, and blood loss. Their measure of cancer removal (no detectable PSA @ 5 years) shows 97% for Robotic Surgery @ Henry Ford vs. 86% for open Surgery @ Henry Ford. This is somewhat disheartening for a person like me who underwent "open" surgery. I don't like the idea of having an 11% better chance of having my cancer recur due to the fact I had "open" surgery.

The big question is.......what in the surgical procedure, robotic vs. open, would make an 11% disparity in the outcome????? I left my phone number with their Urology Institute in an attempt to get an answer to this question, but have not received a call as yet.

Any speculation on where this 11% disparity would come from? It almost appears as the "open" surgery guys were more high risk patients to begin with, but that's hard to believe.

My Urologist performs Robotic surgery, but would only perform open surgery on me due to prior stomach surgery, so it's not like I had a choice anyway.

I think any newly diagnosed visitors to HW considering Robotic Surgery should take a hard look at Henry Ford's Vattikuti Urology Clinic if they're going the surgery route considering their outcome statistics.

Another plus is you do not receive a urethra catheter if you have surgery at their hospital, and they have an online consult form to complete if you wish to consult with their Urologists.

Sunbird:

Some time back geezer questioned the data published on the Henry Ford web site and said he would not believe it unless he saw it published in a respected journal.  I had some time on my hands that day after I read geezer's post and shown below is the reply I posted which I think speaks for itself.

Tudpock

Hi Guys:

In reference to geezer's comment that he wouldn't believe it until and unless published this in a respected journal, I decided to see if I could find such a publication.  As it turns out, Henry Ford DID publish results of a fairly extensive study of their robotic results in 2007 in the "Cancer" journal of the American Cancer Society.  Here is the link for those of you want to read it.

http://www3.interscience.wiley.com/cgi-bin/fulltext/116322982/HTMLSTART

From my analysis, the info published on their web site does appear to be a bit of puffery if compared to the results of their published study.  Now, it may be that this respected institution has other results that back up their web site stats but, if we use the "geezer criteria" of publication in a respected journal, here is what you get:

1.  Cure - defined as no detectable PSA at 5 years.  Web site said 97%, journal study said 84%.

2.  Urinary Function. Web site, defined as no pads needed said 96%. Journal study, defined as less than 1 pad per day said 93%, and said 82% if define as "no leaks".

3. Sexual function - defined as erections good enough for penetration.  Web site said 97%, journal study said 79% (with 44% of those using aids to get it up).  In fairness, the web site states that the 97% is with the "Veil of Aphrodite" procedure while the study included all robotic procedures done at HF.

So, using the "geezer criteria", which I think is excellent, the HF results are good...but not as spectacular as their web site promotes.  As usual, the devil is in the detail.

Perhaps HF will have an upcoming published study that proves their promoted results...in the meantime, it's probably wise to count on what they have pubished under the "geezer criteria".