Archive September 2014 XV, No. 9

Can Outpatient Prostatectomy Be Done?

Same-day discharge after prostate cancer removal is possible, but challenges remain.

Rich Kirkner, Contributing Editor

BIO

robot-assisted prostatectomy PRECISION PROSTATECTOMY Robot-assisted prostatectomy is a cleaner, safer, more pleasant operation than open radical prostatectomy.

Robotic surgery has had a major impact on the surgical management of prostate cancer in the United States. A new study found that more surgeons are performing their prostatectomies robotically. Authors of the study, published in BJU International, looked at the cases of nearly 490,000 men who had their prostates removed between 2003 and 2010. During that time, researchers say that there was a dramatic increase in the number of U.S. surgeons who did at least half of their prostate removals with robotic help, from 0.7% in 2003 to 42% by 2010.

However, during that time, the actual number of surgeons performing prostate removals decreased from 10,000 to 8,200. The authors suggested that as more high-volume surgeons adopted the technology, those who performed only a few cases a year stopped altogether. Mani Menon, MD, director of the Vattikuti Urology Institute at Henry Ford Health System in Detroit, is one such surgeon. “We did 40 consecutive cases over 10 years ago, but we had to discontinue, because insurance companies would not cover it,” he says.

Urology’s great debate
Robotically assisted radical prostatectomy, also known as RARP, aims to eliminate cancer and preserve function. It is associated with minimal bleeding, minimal pain and quick recovery.

The emerging standard for RARP is a 23-hour stay, as Elizabeth Wein, MPS, RN, CNOR, director of surgical services at St. Clare’s Health System in New Jersey explains. “The post-operative care is rather routine in these patients,” she says. “It is considered ambulatory surgery from a reimbursement standpoint, but we do keep the patients overnight.”

Robert Reiter, MD, director of the UCLA Prostate Cancer Treatment and Research Center, is one of the few doctors who will do same-day RARP. He says a patient well suited to the procedure is highly motivated to not spend a night in the hospital and to comply with post-operative instructions. He’s relatively young (40s) and his prostate cancer is in the early stages. Even at that, as an outpatient procedure RARP requires one extra pre-operative step: a magnetic resonance imaging (MRI) the day before the surgery to pinpoint the exact location of the cancer.

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