A new surgical robotic system is “feasible, safe, and effective” for treatment of early-stage prostate cancer, concludes an initial evaluation in The Journal of Urology®, an Official Journal of the American Urological Association (AUA). The journal is published in the Lippincott portfolio by Wolters Kluwer.
The new system, called the KangDuo Surgical Robot-01, offers high accuracy and surgical success with low complication rates and a high comfort level for the surgeon – and may provide a less-costly alternative to current surgical robots. The study was led by Cheng Shen, Xuesong Li, and Liquin Zhou of the Department of Urology, Peking University First Hospital; Institute of Urology, Peking University; and National Urological Cancer Center, Beijing.
Initial experience in 16 patients with localized prostate cancer
The researchers analyzed their experience using the KangDuo system to perform robot-assisted radical prostatectomy (RARP) in 16 men with localized prostate cancer. Robotically assisted surgery for prostate cancer using the groundbreaking da Vinci system has been available for two decades, with demonstrated advantages over conventional open or laparoscopic surgery.
“However, the costs of robotic surgery remain a concern and limit its use,” the researchers write. Developed in China, the KangDuo system has shown promising results in other types of operations.
The patients, median age 66 years, had localized cancers that had not spread beyond the prostate gland. All procedures were performed by Prof. Shen, who previously had extensive experience with prostatectomy using the da Vinci surgical robot. As he gained experience, the surgeon's median time spent behind the console of the KangDuo robotic system decreased from 102 minutes for the first four cases to 75 minutes for the last four.
“These initial results showed that the [KangDuo] system is feasible, safe, and effective for management of localized prostate cancer,” the researchers write. All procedures were successfully completed, with no major problems requiring conversion to traditional open surgery. Seventy-five percent of patients had “clear” surgical margins, suggesting that the cancer was completely removed by surgery.
There were no serious complications and no need for blood transfusions. Urinary incontinence is a potential complication after prostate cancer. In the new study, the continence rate was 87.5% (14 of 16 patients) at one month after catheter removal.
The KangDuo robotic system incorporates several important features to optimize hand-eye coordination and allow for normal and adjustable neck posture. On ergonomic evaluation, the surgeon reported a “high level of comfort” using the robotic surgeon, with “acceptable” levels of mental and physical demand.
The initial experience revealed some minor technical issues – for example, the KangDuo system introduces a foot-operated clutch, which required to additional training time for surgeons who had been accustomed to the manual clutch of the da Vinci robotic system. Further refinements are planned, including a tactile feedback system and the ability to perform long-distance operations using 5G technology.
The researchers highlight the importance of ongoing development of new robotic surgery platforms. “The da Vinci robotic system has dominated the robotic surgery market for a relatively long period, while the development of technology calls for diversification with more innovation,” the researchers write. Estimated costs for research, development and manufacturing are about 25% to 30% of those for the da Vinci system.
Approval of the KangDuo system is expected soon, first in Chinese market and worldwide shortly thereafter. “Although the price has not yet been determined, the emergence of new robotic surgery systems lowers the cost of robotic surgery, which could benefit more patients,” Prof. Shen and coauthors add. They emphasize the need for further study, including longer follow-up and comparison with RARP performed using the da Vinci system.
DOI: 10.1097/JU.0000000000002498
