The Pros and Cons of Keyhole Prostate Surgery

So-called ‘minimally invasive radical prostatectomy’ or MIRP has become increasingly popular in the last 8 years; in 2001 it was done in just 1% of all case of radical prostatectomy, while in 2007 this number had risen to 43%.  Boston physicians and scientists have made a comparison of outcomes from the two types of surgery – MIRP and open retropubic radical prostatectomy (RRP) - and reported their findings in the Journal of the American Medical Association.

The analysis was done on data from the US Surveillance, Epidemiology, and End Results Medicare database.  There were1,938 cases of MIRP and 6,899 cases of RRP.

Not surprisingly, the less-invasive MIRP was associated with a shorter hospital stay (2.0 days vs. 3.0 days with RRP), fewer blood transfusions (2.7% vs.20.8%), and respiratory post-op complications (4.3% vs. 6.6%); there were also fewer surgical complications.  These benefits contrast with a significant increase in some late postoperative complaints: more genito-urinary complications (4.7% vs. 2.1% with RRP), urinary incontinence (15.9% vs. 12.2%) and erectile dysfunction (26.8% vs. 19.2%).

Thee have been direct-to-consumer ads and reported benefits of robot-assisted prostatectomy, which have increased in popularity recently; they form a large proportion of the recent increase in MIRP surgeries.  With this technique, the surgeon uses joysticks, as in a video game, to manipulate the instruments.  It’s possible that the complications of RRP, which has been used for years, are well known and not so fully reported as those with the newer techniques – laparoscopic and robot-assisted MIRP.  Nevertheless, it makes sense for men considering prostatectomy to inform themselves fully of the types of surgery and the experience of the surgeon in the relative procedures; it might make a big difference to their post-operative life.