Advocates of robotically assisted prostatectomy argue that the procedure brings a number of advantages. Among them: less blood loss, shorter stays in the hospital and faster recovery times. However, it isn't clear that the robotically assisted procedures provide an advantage when it comes to survival rates and urinary and erection problems. And it costs significantly more. Ashutosh Tewari, system chairman of the department of urology at Mount Sinai Health System in New York City, believes the robotic surgery is better.
Urology fellow, Jeremy Fallot, and nurse, Shauna Harnedy, assist in robotic surgery by Ruban Thanigasalam (out of view) in Sydney, Australia.Credit: Ken Leanfore for Nature Loved by surgeons and patients alike for its ease of use and faster recovery times, the da Vinci surgical robot is less invasive than conventional procedures, and lacks the awkwardness of laparoscopic (keyhole) surgery. But the robot's US$2-million price tag and negligible effect on cancer outcomes is sparking concern that it's crowding out more affordable treatments. There are more than 5,500 da Vinci robots globally, manufactured by California-based tech giant, Intuitive. The system is used in a range of surgical procedures, but its biggest impact has been in urology, where it has a market monopoly on robot-assisted radical prostatectomies (RARP), the removal of the prostate and surrounding tissues to treat localized cancer. Uptake in the United States, Europe, Australia, China and Japan for performing this procedure has been rapid.
Nine radiologists (three each high, intermediate, low experience) from eight institutions participated. A total of 163 patients with 3-T mpMRI from 4/2012 to 6/2015 were included: 110 cancer patients with prostatectomy after mpMRI, 53 patients with no lesions on mpMRI and negative TRUS-guided biopsy. Readers were blinded to all outcomes and detected lesions per PI-RADSv2 on mpMRI. After 5 weeks, readers re-evaluated patients using CAD to detect lesions. Prostatectomy specimens registered to MRI were ground truth with index lesions defined on pathology.
Procept BioRobotics, a Silicon Valley-based surgical robotics company, recently raised nearly $120 million in private equity to commercialize a treatment for a prevalent prostate condition known as benign prostatic hyperplasia (BPH). BPH, also known as enlarged prostate, affects around half of men age 60 or older and 90 percent of men age 85 or older. Founded in 1999, Procept has pioneered the first commercially available autonomous tissue removal robot to treat BPH. The company's AQUABEAM system uses autonomous robotics and advanced imaging to deliver a heat-free waterjet that removes enlarged prostate tissue. The company has presented clinical research suggesting its method carries less risk of side effects than the current surgical gold-standard, known as TURP.
Rio Tino's autonomous train has completed its first delivery of iron ore in Western Australia's Pilbara. The train, consisting of three locomotives and described by Rio Tinto as "the world's largest robot", travelled over 280km from the company's mining operations in Tom Price to the port of Cape Lambert on Tuesday, July 10. The train was remotely monitored by Rio Tinto's Operations Centre in Perth more than 1,500km away. The locomotives are equipped with AutoHaul software and are fitted with on-board cameras for monitoring from the centre. "We will continue to ensure our autonomous trains operate safely under the wide range of conditions we experience in the Pilbara, where we record more than 8 million kilometres of train travel each year," said Ivan Vella, Rio Tinto Iron Ore managing director for Rail, Port and Core Services.