BPC surgeon Alan Doherty featured in Daily Mail article: is a robot really better at prostate surgery?

The Daily Mail

BPC surgeon Alan Doherty has been interviewed by the Daily Mail in a feature exploring whether robotic surgery is really better than open surgery for prostate cancer.

The feature, published on August 2, follows a study of 326 men, half of whom had robotic surgery for prostate cancer and half underwent open surgery. The study, published in the prestigious Lancet journal found there was little or no difference between the two approaches.

In the article, Mr Doherty, who pioneered keyhole surgery in prostate cancer and is also experienced in using the Da Vinci robotic system, explains why he prefers to use an open surgical approach.
“Why? Because it gives me better results than robot surgery or keyhole surgery,” he explains in the Daily Mail. “When I look at my own results, in terms of men being able to get an erection, they were far more likely to when I used open surgery.”

The article describes how there has been an explosion in the use of and investment in robotic surgery in the past five years. There are an estimated 60 Da Vinci systems in UK hospitals, at a cost of at least £1.5 million each.

Enthusiasts for the robotic approach praise the way the system overcomes the risk of hand tremor and human error. The surgeon works from a console within the Da Vinci system and works from a 3D, highly magnified images of the prostate and surgical field. Mr Doherty, however, says this does not compensate for the lack of touch when a surgeon is operating using open techniques and can judge how tissue feels as well as how it looks.

The Lancet study found that men who had robotic surgery were in less pain immediately after surgery and had better quality of life scores at six weeks. But after 12 weeks, there were no significant differences between the two. The study was undertaken at the University of Queensland in Brisbane, Australia.

Mr Doherty comments: “I think this is a really significant study and I also welcome the Daily Mail article, which explores the relative merits of robotic and open surgery in a thoughtful and balanced way.

“The Australian study echoes my clinical practice: using minimally invasive techniques to do surgery (either laparoscopic or robotic), hospital stay is shorter by two or three days and with a smaller wound, there is less discomfort immediately after surgery. So I would recognise that at six weeks, patients are likely to do better on quality of life scores after minimally invasive surgery compared with open.

“But the outcome of prostate cancer surgery men are most concerned about, after cancer clearance, is continence and erectile function. Evidence from my own audit showed for these outcomes, measured at 12 weeks, six months and one year, the best results come from open surgery.

“In other words, ask the patient what is most important to them: how you feel six weeks after surgery? Or whether you are continent and able to return to your normal sex life several months after surgery? We need to ensure that the outcomes that we measure and value are the ones that matter to patients.

“I am not anti-technology at all, but my concern with robotic surgery is that it has been rolled out very quickly across the UK, in areas like London wiping out the practice of open prostate cancer surgery. We don’t have a sufficient evidence base for robotic surgery and where outcomes are given, they are not necessarily the ones that really matter to patients or the surgeon’s own results.

“This study shows there is no significant difference in outcomes at 12 weeks and I would also add that the surgeon carrying out a prostatectomy – their experience and ability – is the most important factor of all in terms of quality and outcome.”