Is robotic surgery best treatment choice for bladder cancer?

The da Vinci robotic device may have revolutionized surgery, but, for all of the device’s advantages, it may not be the best approach in all cases.

That’s the conclusion of a recent New England Journal of Medicine study, in which researchers reported that patients who opted for the more expensive robotic approach to treat their bladder cancer following consultation with their surgeons fared no better than patients who underwent traditional, open surgery.

The da Vinci device offers physicians a magnified surgical field, eliminates natural hand tremors, reduces surgeon fatigue and utilizes smaller, easier-to-maneuver instrumentation, which allows surgeons to make smaller incisions.  These advantages tend to translate into less damage to tissue, less blood loss and less pain for the patient and quicker recovery times.  However, the average cost of a robotic surgery is an estimated $1,600 to $3,200 more per procedure, according to the American College of Surgeons.  These extra operative costs are offset somewhat by shorter hospital stays and faster patient recovery times.

In the double-blind study, researchers profiled a random sample of 118 participants who had been diagnosed with invasive bladder cancer and required surgical care.  The study authors followed the patients postoperatively for a period of time, eventually concluding that patients undergoing robotic surgery experienced no significant differences in outcomes than those who were treated with a more traditional approach.

“Advanced bladder cancer patients are typically older patients with other medical problems,” said Dr. Aaron Berger, urologist at Advocate Christ Medical Center.  “Our primary concern always is to treat patients using the safest method, while reducing chances for postoperative complications.”

It’s important to remember that results from this study are related specifically to the treatment of bladder cancer – not all minimally invasive procedure performed with the da Vinci device,” Dr. Berger said.  “Using the da Vinci for removal or reconstruction of a bladder is a fairly new procedure.  We need a more robust study with a larger sample size to truly understand the long-term impact on our patient population.”

The American Cancer Society estimates that some 74,000 Americans receive a bladder cancer diagnosis each year.