Table 3.
Exemplars of physician portrayals of robotic prostatectomy within specific clinical categories.a
Clinical Category | Portrayal of robotic prostatectomy
|
|
---|---|---|
Equivalent | Superior | |
Blood loss | The risks for surgery are both pretty similar. There’s risk of infection, risk of bleeding. | The advantage of the robot is there is less blood loss. |
Incisions b | You do have some smaller incisions with the robotic, but if you added up all the incisions from all the ports and from the incision to remove the prostate itself, it ends up equaling about the same incision length. | The advantage to [robotic surgery] is small incisions and not cutting belly muscle. |
Visualization | n/a | One of the aspects about robotic surgery is that the visualization is tremendous. It’s all in high definition; it’s three dimensional in my screen where I’m looking. |
Hospital stay | You’re in the hospital for the same amount of time either way. | There is a shorter hospital stay by about twelve hours [with robotic surgery]. |
Recovery | They haven’t even been able to show a faster recovery time for the robotic surgery. | The benefit of [robotic surgery] is that there’s quicker recovery after surgery. |
Pain | Post-operative pain, that sort of thing, is kind of a wash. | There is less pain with a robot. |
Cancer cure | Cancer outcomes: Is there a difference in margin rates, getting the prostate cancer out? No. | n/a |
Impotence | The erections after [robotic surgery] are not any better. | We’re probably doing a better job sparing the nerves [with robotic surgery], which is what’s important for preserving erections. |
Incontinence | I’ll be honest, there’s no difference in the outcomes in urinary control, having the open surgery versus having the robot. | I think I’ve really seen a difference in the urine control and when that comes [earlier with the robot]. |
Note. n/a indicates that physicians never portrayed robotic prostatectomy in that manner.
Due to space constraints, the table only includes exemplars from categories that physicians compared in >10% of the appointments that discussed robotic prostatectomy.
In the category of incisions, the physician described robotic prostatectomy as inferior in two appointments (e.g. “If you added up all the holes for the robotic surgery, it adds up to probably more than that [from open surgery] by the time that you get all the little cuts put together.”) For ease of presentation, this was omitted from the table.