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Using a Surgical Robot to Remove Cancerous Prostates

May 31, 2022

A 20-year review of surgery to remove cancerous prostates at Hartford Hospital with the DaVinci surgical robot highlights an evolving landscape for the treatment of prostate cancer and its outcomes.

Joseph Wagner, MD, chief of urology at Hartford Hospital and director of robotic surgery at Hartford HealthCare, along with the robotic/urologic oncology fellow, Alex Bandin, MD, presented the results of his study, “A 20-Year Follow-Up Study of Oncologic Outcomes, Quality of Life and Complications in Patients Undergoing Robotic Radical Prostatectomy” at the recent annual meeting of the American Urological Association.

“Within 10 years of its approval, surgeons were using the DaVinci surgical robot for the majority of prostatectomies in the United States,” Dr. Wagner said of the procedure to remove the entire prostate after the spread of cancer. “That includes our teams at Hartford Hospital.”

He and his research team analyzed a prospective maintained database spanning 20 years to determine if using the less invasive technique afforded by the surgical robot made a difference in the patients’ lives, including reducing their risk for complications and improving their ability to maintain continence and erections after the procedure.

More than 3,100 patients in that timeframe were divided into five-year groups to evaluate any changes in quality of life and oncological outcomes over time.

“We discovered that complication rates decreased from 16 percent to 3.6 percent overall,” Dr. Wagner said. “Continence rates one year after the surgery improved from 74.8 percent to better than 92 percent.”

In addition, he said the time to complete the radical prostatectomy dropped from 199 minutes to 167, although in the more recent cohorts, the times have nudged up slightly due to increased teaching.

“In this 20 year review of our experience with robotic prostatectomy, complication rates and continence improved over time,” Dr. Wagner said. “It also clearly shows the increased role active surveillance plays in the treatment of prostate cancer, as low risk men are advised to avoid surgery. This study provides insight into the changing landscape of prostate cancer treatment over the past two decades.”

At the same conference, Dylan Buller, MD, a University of Connecticut Medical School resident training at Hartford Hospital, earned a blue ribbon for his poster presentation entitled “Prostate Cancer Detection and Complications of Transperineal vs. Transrectal MRI-Fusion Guided Prostate Biopsies.”

Dr. Buller collaborated with Dr. Wagner and others to compare the two ways of getting a prostate biopsy, and determined which yielded better detection rates and fewer complications. By reviewing results retrospectively in patients having a biopsy between August 2020 and August 2021, the team determined that neither approach offered significantly different results.