David Albala, MD
For patients undergoing a prostatectomy, robotic surgery can provide several benefits, according to David Albala, MD. Compared with open surgery, undergoing a robotic prostatectomy can result in fewer reports of pain and blood loss, as well as shorter hospital stays.
In an interview with OncLive
during the 2016 LUGPA Annual Meeting, Albala, urologist and medical director with Associated Medical Professionals, discussed some of the benefits of robotic surgery and the impact it has had on the field of prostate cancer, as well as methods that larger urology groups can use to better achieve compliance.
OncLive: Can you discuss the role of robotic prostatectomy in treating patients with prostate cancer?
: In 2016, robotic surgery does have a firm implant in urological surgery, especially in oncology with prostatectomy, partial nephrectomy, and cystectomy work. The real benefit of robotic surgery is that patients can leave the hospital—the recovery time is much, much quicker than open surgery. It’s a minimally invasive procedure so there is less pain, and there’s less blood loss associated with these procedures. Now, an experienced robotic surgeon can do these procedures in a timely fashion.
Obviously, there’s a learning curve that’s associated with robotics, but most of us have passed that learning curve. We now have done 1000 to 3000 prostatectomies. The learning curve has passed.
The time of surgery is equivalent to open surgery, and, really, the efficacy of the procedure, complication rates, impotence, and incontinence are the types of complications similar to what we see in open surgery.
The patient benefits because the recovery time is much quicker, they’re out of the hospital typically in 1 day, and a catheter is left in place for approximately 1 week, which is somewhat shorter than what we saw in open surgery.
In prostatectomy, there are clearly benefits. For partial nephrectomy—taking out kidney tumors—these patients in my practice typically stay in the hospital overnight and are able to leave the hospital the next day. Many of the same benefits we see with prostatectomy can be translated into partial nephrectomy and cystectomy.
Are there patients who are better suited for robotic surgery than others?
All patients who are surgical candidates for the procedure can have it be done robotically. If a patient is a candidate for a prostatectomy, whether you do it with a retropubic approach, perineal approach, or robotic approach. All of those patients can be done robotically.
Obese patients can be done robotically with the new da Vinci System. These have longer reaches for their instruments; these procedures can be done with greater ease. Those were difficult with some of the earlier prototypes of the robot but, as the evolution of the robot has taken place, we can now do this on the obese patient much better, and so we get better results.
Really, anything we can do with an open procedure, we can do robotically.
What impact has robotic surgery had in the field of prostate cancer?
The real benefit has been the shorter recovery time. There’s good documentation in the literature about blood loss. The average blood loss for a robotic prostatectomy is about 150 cubic centimeters, which is a small amount compared with an open prostatectomy—which is 700 to 1000 cubic centimeters—so there is quite a difference.
Clearly, the hospitalization time is shorter robotically, although lines get blurred. If you are a very experienced open surgeon, you can have tremendous outcomes that are very comparable with what we see robotically.
The efficacy of the procedure and the complication rates are comparable. Where robotics really help patients are with blood loss, length of stay, and catheter drainage time.
At LUGPA, you gave a presentation on achieving compliance in a large urology group. What were the key points of your presentation?
Compliance within large urology groups is really an important quality of a practice not only for reimbursement, but also to avoid penalties.
Dr Carl Olsson and I essentially went through steps we believe practices can institute relatively easily to avoid the penalties of the federal government coming in and creating penalties on these practices.
For example, we audit charts 2 or 3 times per year of each individual physician. What that does is allow us to see where the physician is in his coding, where the documentation of that physician is. If it’s lacking certain measures, we can sit down and educate the physician and try to bring their standard up to a certain baseline level that we would expect the whole practice to do.