Robotic surgery for the treatment of prostate cancer is growing by approximately 40% per year in South Africa and is increasingly being adopted as treatment of choice for high-risk and medium-risk cancer cases. Furthermore, this form of surgery is having a highly positive impact on local healthcare, and on urological medicine in particular, since its introduction in recent years.
This is according to Dr Greg Boustead, a specialist urologist and robotic surgeon, who was speaking about the outcomes that had been achieved by the Netcare da Vinci robotic programme, based on the initiative’s first 500 robotic assisted radical prostatectomies. Dr Boustead presented the findings of this study at the World Congress of Endourology and the South African Urological Association Meeting, which is being held in Cape Town from 8 to 12 November.
Dr Boustead, who has led the Netcare robotic-assisted surgery programme since its inception in June 2014 and has so far assisted in the training of 18 robotic surgeons using the robotic technology at Netcare Waterfall City, Netcare Christiaan Barnard Memorial, and Netcare uMhlanga hospitals, said that there are now more than 3 500 da Vinci Robots globally, and more that 80% of all radical prostatectomies are being performed robotically.
“Radical prostatectomy, the surgical removal of the prostate gland, remains the global gold standard for treating intermediate and high risk prostate cancer, and as can be seen, robots are increasingly being used both locally and internationally to assist with these procedures,” said Dr Boustead.
“The results of the Netcare study, which draws on the data from the 500 procedures conducted at the three Netcare hospitals offering robotic-assisted surgery, confirm that robotic surgery offers excellent outcomes and effective early cancer control at a median follow up of 13 months in a cohort of male patients, more than half of whom had intermediate-risk or high-risk prostate cancer.
“In the study, robotic surgery patients had a hospital stay of almost half the duration as with traditional open prostate surgery; i.e. a median of 3.2 days when compared with a median of six days in the open surgery patients. In other words, the robotic surgery patients recovered from their procedures far quicker.
“Perhaps even more important, the patients who were operated on with the assistance of the da Vinci robotic system suffered less than half the complication rates than those individuals who underwent open surgery. The risk of severe complications arising from robotic-assisted surgery was substantially lower at 1.6%.”
Dr Boustead said that the aim of the Netcare robotic programme study was two-fold: Firstly, to ensure the safe rollout of a local robotic prostatectomy initiative that would achieve outstanding cancer control and good outcomes in multi-speciality hospital environments, while simultaneously training surgeons.
“Secondly, we were also able to compare the length of hospital stay and complication rates with a cohort of age-matched men treated over the same time period by means of traditional open radical prostatectomy in similar facilities.
“When we look at single surgeon data of our highest volume surgeons, both blood loss and continence outcomes continue to improve as surgeons gain more experience. Just 1.7% of the men who underwent robotic-assisted surgery required a blood transfusion during the procedures.
Outcomes with regard to urinary continence and recovery of sexual function were excellent and equivalent to those of other studies conducted around the world into robotic-assisted prostatectomies.
“Studies from around the world are confirming a lower risk of primary treatment failure after robotic-assisted surgery. Primary treatment failure may then require secondary treatment, which carries the risk of additional side effects as well as substantially increased costs,” pointed out Dr Boustead.
The robotic surgical teams need to be highly trained and Netcare therefore introduced thorough training initiatives for urologists and support staff. These cover both product and clinical aspects through a series of online modules, simulator training, as well as hands-on surgery performed in an accredited training laboratory in Belgium. As the Netcare programme’s proctor, Dr Boustead oversees the procedures until the doctors are fully versed and well experienced in the use of the robotic technology.
Jacques du Plessis, managing director of the Netcare hospital division, congratulated Dr Boustead and all of the members of the Netcare da Vinci robotics programme on the results of the study. “These findings demonstrate the great success of the programme, which continues to strengthen and grow in importance year after year since its introduction into our hospitals in 2014,” he adds.
“As is evidenced by the rapid uptake of robotic-assisted surgery by both patients and referring doctors, there is a great and growing demand for this form of treatment. In addition, it is evident that the programme is making an important contribution to the development of medical skills in this country,” concludes Du Plessis.
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