"It allows us to remove the prostate safely and effectively, while at the same time, achieving excellent cancer control, return of continence and also return of sexual function and we can do it in a minimally invasive way," says Dr. Patel. "I trained in the era of open surgery and then I did a fellowship in laparoscopy, but when I saw the robotic applications, I really felt [it was the future] because we could do everything we could do with open surgery and more."

Dr. Patel is one of the founders of the Journal of Robotic Surgery and the Society of Robotic Surgery. He sees the journal as a way to disseminate new data about techniques and outcomes and the society as a place for education. More than 1,100 surgeons attended this year's World Robotic Symposium in April.


"They came from 37 different countries from around the world," says Dr. Patel. "It's the first time that so many people from so many different countries have come to one place just to learn about robotics in all of their different specialties."

Attendees discussed technology, outcomes, simulations, techniques and future applications at the conference.

St. Luke's Hospital and Health Network in Pennsylvania offers a limited clinical guarantee on its robotic prostatectomies. Urologic surgeons developed a set of strict guidelines for the surgery. The hospital guarantees that if the surgeons fail to abide by the established regulations or if a patient develops specific complications due to the surgery within 30 days of the procedure, the operation is free of charge. When the technique was in its early stages of development, the surgeons at the hospital realized that the expertise of the team actually doing the procedure is far more important than the instruments themselves. This prompted the idea of offering a limited guarantee to their patients.

"When the decision was made to advertise the fact we do robotic surgery, one of the things we wanted to stress is, it's one thing to advertise a given service, but it would be nice to be able to substantiate that or offer some sort of background or proof that the results are there," says Dr. Eric Mayer, chief of minimally invasive urologic surgery at St. Luke's Hospital and Health Network.

At St. Luke's, most patients scheduled for prostate cancer surgery choose robotic prostatectomy.




"Of those patients who undergo surgery, I would say roughly 98 percent undergo the robotic approach. The 2 percent that we do traditionally are usually done this way because they have certain contrary indications to the robotic surgery," says Dr. Mayer. "For example, if they're morbidly obese or if they had multiple abdominal surgeries in the past, the robotic instrumentation might not have safe access. It's pretty far and few between that we do have to do open surgeries," he says.

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