Robotic Prostate Surgery: State of the Art?

Feb. 21, 2006 — -- Lewis Weitzner found out he had prostate cancer last September, when he was 51 years old.

Although the many options available to men in his situation can be confusing, deciding what treatment was easy for him, he said.

"I was already sure I wanted it removed with surgery," Weitzner said. "I did not want to play around."

Weitzner was one of the more than 232,000 men in the United States diagnosed with prostate cancer last year. Men in his situation face a difficult decision: what kind of treatment to choose. It's the focus of "Second Opinion: Prostate Cancer," a "World News Tonight" series by ABC News Medical Editor Dr. Tim Johnson that's airing this week.

Weitzner opted for one of the newest types of prostate cancer treatments -- robotic radical prostatectomy.

While traditional surgery is preformed through a single large incision in the lower abdomen, robotic surgery requires several tiny openings for the arms of the robot, the camera, the surgical assistant and a suctioning device.

As a 3-D camera gives a highly magnified view inside the patient, the surgeon operates the robotic arms from a console nearby. Pressurized gas pumped into the abdomen means there's little bleeding.

"The sheer absence of bleeding allows for a pristine [view] and allows you to identify all the structures you normally have a difficult time seeing through traditional open surgery," said Dr. John Phillips, the physician in charge of urologic oncology at Beth Israel Medical Center in New York.

It also has other advantages for the patient, he said.

"Patients have quicker recovery and overall do better, get out of the hospital faster and have less pain," he said.

Weitzner agrees.

"I cannot even see the scars. They're small little slits," he said. "You can't even see where it was done. It's a remarkable thing."

But Dr. Peter Albertsen, a professor of surgery at the University of Connecticut Health Center, said that the robot's advantages are insignificant when compared with traditional open surgery done by experienced doctors.

"Is it cheaper? No. Does it get the patient out significantly earlier? No. Does it lead to higher rate of continence? No. Does it improve sexual function afterward? We don't think so. So then the question is, What is the advance?" Albertsen said.

Is It Worth It?

Experts agree that robotic surgery is often overpromoted, and they said that picking an experienced surgeon with a proven track record is more important than choosing between open or robotic surgery.

Patients are advised to ask a surgeon about his or her track record and about any known side effects of the procedure.

And experts emphasize that men should take their time in deciding among the many different options for prostate cancer treatment -- surgery, radiation or sometimes, no treatment at all.

But for Weitzner, robotic surgery was the right decision.

"I have no reason to look back and say, 'Gee, should I have done it another way?'" he said.