Robot-assisted laparoscopic radical prostatectomy (RALRP) using the da Vinci surgical system is now in widespread use in many countries where economic conditions allow the installation of this expensive technology. Controversy has surrounded the procedure since it was first performed in 2000, with many critics highlighting the lack of evidence to support its use. However, despite the lack of level I evidence, many large studies of patients have confirmed that the procedure is feasible and safe, with low morbidity. Available longer-term oncological data seem to show that outcomes from the robotic approach at least match those of traditional open radical prostatectomy. Functional outcomes also seem satisfactory, although randomized controlled trials are lacking. This paper reviews the current status of RALRP with respect to perioperative data and complications and oncologic and functional outcomes.
Erectile Dysfunction ; etiology ; Humans ; Laparoscopy ; methods ; trends ; Male ; Prostatectomy ; adverse effects ; instrumentation ; methods ; Prostatic Neoplasms ; surgery ; Robotics ; methods ; trends ; Treatment Outcome ; Urinary Incontinence ; etiology

The da Vinci S surgical system (Intuitive Surgical) was approved as a medical device in 2009 by the Japanese Ministry of Health, Labour and Welfare. Robotic surgery has since been used in gastrointestinal, thoracic, gynecological, and urological surgeries. In April 2012, robotic-assisted laparoscopic radical prostatectomy (RALP) was first approved for insurance coverage. Since then, RALP has been increasingly used, with more than 3,000 RALP procedures performed by March 2013. By July 2014, 183 institutions in Japan had installed the da Vinci surgical system. Other types of robotic surgeries are not widespread because they are not covered by public health insurance. Clinical trials using robotic partial nephrectomy and robotic gastrectomy for renal and gastric cancers, respectively, have recently begun as advanced medical treatments to evaluate health insurance coverage. These procedures must be evaluated for efficacy and safety before being covered by public health insurance. Other types of robotic surgery are being evaluated in clinical studies. There are several challenges in robotic surgery, including accreditation, training, efficacy, and cost. The largest issue is the cost-benefit balance. In this review, the current situation and a prospective view of robotic surgery in Japan are discussed.
Cost-Benefit Analysis ; Esophageal Neoplasms/surgery ; Gastrectomy/*methods ; Gynecologic Surgical Procedures/methods ; Humans ; Japan ; Laparoscopy/*methods ; Nephrectomy/*methods ; Otolaryngology/methods ; Prospective Studies ; Prostatectomy/*methods ; Rectal Neoplasms/surgery ; Robotic Surgical Procedures/education/*trends ; Stomach Neoplasms/surgery ; Thymectomy/methods ; Thyroid Diseases/surgery

PURPOSE: We analyzed changes to the trends of prostate cancer management and patient characteristics at a single institute during 5 years due to the significant increase of the prostate cancer incidence and the robotic equipment in Korea. MATERIALS AND METHODS: Prostate cancer patient data from a single institute recorded from 2006 to 2010 were analyzed. Cancer stage, initial treatment modalities, and the pattern of outpatient clinical management were reviewed. RESULTS: Between 2006 and 2010, 386 prostate cancers were newly diagnosed at the institute. The proportion of localized and locally advanced cancer cases increased from 67% in 2006 to 79% in 2010 respectively. Among the treatment choices during follow-up in the out-patients clinic, the proportion of radical prostatectomies increased from 43% in 2006 to 62% in 2010. In contrast, the proportion of hormone therapies decreased from 58% to 37%. For initial treatment choice, radical prostatectomy was chosen for 59% of the patients who were newly diagnosed with cancer during the study period. However, hormone therapy alone was administrated as a primary therapy to 26%. Analysis of the radical prostatectomy subgroup showed that a robot-assisted technique was used in 83% of the patients, and the remaining 17% underwent an open radical prostatectomy. CONCLUSION: As the prostate cancer incidence increased in Korea, the proportion of localized and locally advanced cancer also increased. In addition, the main treatment modality changed from non-surgical treatment to radical prostatectomy.
Databases, Factual ; Follow-Up Studies ; Hormones/*therapeutic use ; Humans ; Male ; Prostatectomy/*methods/trends ; Prostatic Neoplasms/*therapy ; Republic of Korea ; Robotics ; Time Factors ; Treatment Outcome