few small incisions or even a single incision. Robotic prostatectomy
has evolved into the preferred method for both surgeons — who pre-
fer the precision and ease of operating robotically — and patients,
who recover sooner and with fewer complications.
"About 90% of all prostatectomies in the country are done robotical-
ly," says Ryan Dobbs, MD, a robotics fellow at the University of
Pennsylvania Medical Group in Philadelphia. He says the increasing
numbers of robotic prostatectomies are helping to shift more cases to
outpatient facilities.
"It would be unimaginable to safely discharge patients on the day of
surgery without the robot," explains Dr. Dobbs. "We can after robotic
procedures because patients lose less blood and, because we're mak-
ing smaller incisions, they have less pain. These factors make the pro-
cedure safer and feasible in outpatient ORs."
Jihad Kaouk, MD, says the robot is also more effective for operating
on patients who are obese, have had previous abdominal surgery or
present with a complex or enlarged prostate.
Learning to use the robot is fairly straightforward, according to Dr.
Kaouk, a professor of surgery and director of the Center for Robotic
and Image Guided Surgery at the Cleveland Clinic. "The short learning
curve is why the vast majority of urologists now perform the proce-
dure robotically," he says.
Surgeon experience still matters, however. "The robot is a tool —
there's nothing magical about performing the procedure with a robot
and complications can still happen," says Dr. Kaouk. "The robot is a
machine and its performance depends on the skill of the surgeon."
Changing the mindset
Educating patients about the benefits of robotic prostatectomy and
preparing them for same-day discharge are keys to performing the
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