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Robots Find a Home in Prostate Cancer Guidelines: Presented at NCCN
By Ed Susman
HOLLYWOOD, Fla -- March 12, 2008 -- Robot-assisted prostatectomy has earned a place alongside laparoscopic surgery and open surgery for prostate excision due to malignancy.
"We have changed the new guidelines for prostate surgery to include open, laparoscopic, and robot-assisted procedures for radical prostatectomy," said James L. Mohler, MD, Chairman, Department of Urologic Oncology, Roswell Park Cancer Institute, Buffalo, New York.
Dr. Mohler presented the updated guidelines for prostate cancer here on March 6 at the National Comprehensive Cancer Network (NCCN) 13th Annual Conference: Clinical Practice Guidelines and Quality Cancer Care.
The guidelines now consider the 3 procedures as offering equivalent results, Dr. Mohler said.
At Roswell Park, he now performs all his prostatectomies using the DaVinci robot system. In demonstrating how the device worked in a brief video at the NCCN meeting, Dr. Mohler said, "You can see that the robot arms do not shake. Most surgeons who perform radical prostatectomies using laparoscopic devices will insist their devices don't shake either, but they do."
He said that in the past 2 years he has performed about 500 DaVinci robot-assisted prostatectomies and that his patients have appreciated that they are not left with major scarring, that they have to spend just one night in the hospital, and that they can return to normal activities of daily living within a few days rather than months.
Dr. Mohler noted that a published study (Sarle R. J Endourol. 2003) demonstrated that when compared with a laparoscopic surgeon, the robot-assisted surgeon could perform several precise tasks involving suturing organs faster.
The new NCCN guidelines for prostate cancer surgery require that doctors and patients discuss the possibility of expectant management before considering radical prostatectomy. The guidelines also specifically rule out any use of neoadjuvant androgen-deprivation therapy prior to radical prostatectomy in patients with low- to intermediate-risk prostate cancer.
The guidelines also suggest that patients who opt for radical prostatectomy undergo the procedure at centres where there is a high volume of procedures and where the surgeons have a high volume of experience in performing the delicate surgery.
[Presentation title: 2008 Update Prostate Cancer Guidelines.]
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