It’s not news that radical prostatectomy (RP), including robotic assisted laparascopic prostatectomy RALP), has the potential for urinary and sexual side effects. Over time, most of them improve with or without treatment. Surgery patients generally accept the risk, and learn to manage if they experience short or long term side effects. However, as with any invasive surgery, there is also a chance of immediate complications that result from the procedure itself. There is a special term for this: iatrogenic injury (pronounced ? at? r? jenik). Because the prostate gland occupies a protected position in close proximity to the rectum, with the urethra passing through the gland, prostatectomy comes with some risk—however small—of internal harm requiring additional hospitalizaton. Common sense suggests that the less invasive a surgical procedure, the less potential for injury to nearby structures. It appears, however, that even robotic surgeons who are new at their technique are more likely to inflict unintended harm than when they become more experienced.
I came across a newly published study called “The Safety of Robotic Prostatectomy Over Time: A National Study of in-Hospital Injury.”[i] The authors had access to a database of prostatectomy patients from 2001 to 2011. They identified 219,434 robotic patients with a goal of determining the rate of iatrogenic complications over time and the length of hospital stay resulting from treating them. The study assumes a “learning curve” for robotic surgery, such that the risk of iatrogenic complications would be greater in the early stages of a surgeon’s experience.
As expected, they found that the frequency of iatrogenic complications for robotic patients decreased from years 1-2 to the later years 9-11. According to the authors, once a robotic surgeon has overcome the learning curve, minimally invasive surgery is considered safer than open surgery. However, the length of hospital stay increased for those who experienced surgery-related complications because iatrogenic injury increases the burden of patient care.
We will never know which of those 200,000 men might have been candidates for a focal ablation if they would have had access to it. I do not suggest that focal ablation is without risk, but it is certainly far safer than surgery. It is my hope that early, accurate detection and diagnosis make it possible for many more men to control their cancer through targeted treatment such as our focal laser ablation, and avoid the chance of treatment-related complications.
[i] Chughtai B, Isaacs AJ, Mao J, Lee R et al. Safety of robotic prostatectomy over time: a national study of in-hospital injury. J Endourol. 2014 Aug 21. [Epub ahead of print]