The article is interesting but comes across as a promotional piece (e.g. isn't technology wonderful!).
One thing this article fails to mention is that there are several studies showing that for patients with muscle-invasive blc (and that's if the patient/surgeon know this for sure BEFORE surgery - keep in mind that cancer is upstaged quite often and that what is thought to be superficial cancer often turns out to be muscle and/or lymph node invasive AFTER surgery), oncologic outcomes are better when extended lymph node removal is done. 25 nodes removed may be better than 5, or 35 vs 25 or 65 vs 35. By selectively omitting such important information, it seems to me that that this cancer center is trying to increase patient volume to cover the considerable overhead associated with the purchase of their "state of the art miracle" machine.
Instead, today, I'd feel much more comfortable choosing the surgeon over Da Robot (and I don't mean to minimize the benefits of technology). But especially if one has muscle-invasive blc, go with a top surgeon who remove lots of lymph nodes rather than focus on shorter time on the operating table...
Also, why the scare tactics when comparing laparaoscopie to open surgery (e.g. loss of five times the blood, greater chance of infection and incontinence and impotence...). The statistics quoted by the author of the article may be all too real for some, but I don't believe they are representative of the top surgeons at the top institutions. None of this happened to me - plus I had nerve sparing surgery and (to my relief), it worked (no pills/shots needed...).
Here's what Dr. Stein has to say about laparaoscopic RC:
PURPOSE OF REVIEW: Radical cystectomy with an appropriate lymph node dissection... is the standard treatment for muscle-invasive transitional cell carcinoma... Optimal outcomes following radical cystectomy require an extended lymph node dissection, negative surgical margins... There has been an increasing number of reports describing initial experiences with laparoscopic radical cystectomy.
RECENT FINDINGS: Intermediate and long-term oncologic outcomes with laparoscopic radical cystectomy remain undefined, and appropriate lymph node dissections laparoscopically have not been uniformly performed. Furthermore, the long-term functional outcomes associated with laparoscopically performed urinary diversions also remain undefined. There appears to be a recent trend toward performing the urinary diversion portion of the procedure extracorporeally, after laparoscopic removal of the bladder. Some studies suggest a decrease in postoperative analgesic requirements and quicker recovery of bowel function in those undergoing laparoscopic radical cystectomy, but these observations have not been corroborated by others.
SUMMARY: In the absence of long-term functional and oncologic outcome data, laparoscopic RC should be considered an investigative technique, and potential candidates for this operation should be appropriately counseled.
His summary is prudent and reasonable. It's great to use laparaoscopic surgery, one's results may be great, it may be one's best option given the choice of doctors... it's just that all of the supporting data does not yet exist.
