Laparoscopic radical prostatectomy (LRP) using robotic technology may improve survival of patients with prostate cancer by decreasing the frequency of resections with positive surgical margins, according to a presentation at the annual meeting of the American Urological Society.

“We demonstrated a significant improvement in the positive surgical margin rate with the addition of robotics to an established LRP,” said Costas Lallas, M.D., assistant professor of Urology, Jefferson Medical College of Thomas Jefferson University, one of the investigators. Lallas completed a robotic surgery fellowship at the Mayo Clinic.

“Several large studies have demonstrated that a positive surgical margin increases the chances that the prostate-specific antigen will rise after surgery, and increase the chances that the disease will reoccur and progress,” said Edouard Trabulsi, MD, assistant professor of Urology, Jefferson, a urologic oncologist and an expert trained in laparoscopic prostatectomy by one of the pioneers of the technique. “Therefore, any intervention or technique to lower positive surgical margins, we think, will translate into a better long-term cure rate.”

In the current work, researchers at a high-volume center with an established program reviewed the cases of 247 men with clinically localized prostate cancer treated with either traditional laparoscopic radical prostatectomy or robotic assisted laparoscopic prostatectomy from March 2000 to August 2006. Of the 247 cases, 197 patients underwent traditional surgery and 50 patients underwent robotic assisted laparoscopic prostatectomy.

The overall positive surgical margin rate for patients who had traditional surgery was 18 percent compared with 6 percent for patients who had robotic-assisted surgery.

“We individualize each case and consider the patient, as well as his particular anatomy and preoperative cancer-related characteristics to plan his procedure,” said Lallas. “In addition, the majority of our patients are evaluated in a multidisciplinary genitourinary cancer clinic, emphasizing our focus on the oncologic aspect of this operation.”

The robotic system refines laparoscopic prostatectomy by allowing a surgeon’s hand movements to be scaled, filtered and translated into precise movements of micro-instruments within the operative field. The magnified, three-dimensional view provided by the technique allows the surgeon to perform precise surgery, even in complex procedures.