AORP brings greater precision to open prostatectomy and delivers faster functional recovery, without requiring expensive equipment.
O prostate cancer It is the most frequent type of cancer among men in Brazil, with the exception of skin cancers. non-melanomaThis puts pressure on the healthcare system to seek out effective, safe, and affordable surgeries.
A radical prostatectomy Complete removal of the prostate with curative intent has changed significantly in recent decades. The challenge is to expand the gains in precision and recovery, even in areas where robotics is not yet available.
What happened and why did it attract attention?
A team from Pedro Ernesto University Hospital da Uerj developed the AORP, an acronym for open anatomical radical prostatectomy. The technique brings to open surgery principles that became popular with robotics.
The proposal is clear: to improve previewrefine the dissection and preserve important structures, using only conventional tools. All this without creating additional costs for the procedure.
How prostate surgery has evolved in recent decades.
Em 1980the urologist Patrick Walsh showed that it was possible to preserve the nerves connected to erection during surgery. This change reduced complications and improved quality of life after the procedure.
In the decade of 1990, laparoscopy It resulted in smaller incisions and faster recovery. However, the technique requires high skill and a long learning curve, which has limited its widespread use.
In the years 2000Robotics gained ground with the system. da Vinciwhich enhances precision and offers three-dimensional vision. The advancement was hampered by… extremely high cost acquisition, maintenance and disposable instruments.
What robotics delivers and where it still falls short.
Robotic surgery facilitates the performance of prostatectomy via laparoscopy and usually speeds up the process. recoveryEven so, results oncological The functional outcomes appear to be equivalent to those of traditional open surgery, with the main advantage concentrated in the postoperative period.
In middle-income countries, the expansion of robotics is limited by the necessary investment. This creates technological inequality and keeps many services dependent on open surgery.
The practical question becomes a priority: how to capture the gains in technique and anatomical preservation without relying on high-cost platforms.
How does AORP work in open surgery?
A AORP it was structured in 2015 Following a comprehensive review of open, laparoscopic, and robotic approaches, this technique focuses on the anatomical logic of dissection and reconstruction, with steps designed to increase precision.
Three pillars were identified as crucial for achieving better functional outcomes: anterograde dissectionpreservation of bladder neck and the abdominal urethra, and continuous anastomosis by the technique of Van Velthoven.
With this, the team sought to replicate the gains attributed to robotics, but using only traditional materials and instruments. The goal is to raise the standard of open surgery without increasing costs.
What are the rules, deadlines, and conditions in clinical research?
The research followed scientific practices with the approval of Ethics Committee from the Pedro Ernesto University Hospital. There was a record at Clinical Trials, reinforcing the control of each step and the transparency of the protocol.
A pilot study with 10 Patients paved the way for a larger evaluation. Subsequently, a randomized clinical trial with… 240 patients, between 2016 e 2019.
This design allowed for a comparison of AORP with the traditional technique under standardized conditions, observing both safety and functional results.
Results observed in continence, complications, and cancer control.
Patients who underwent surgery with AORP They experienced less blood loss and shorter anastomosis times. There was also a reduction in the duration of use of urinary catheter and faster urinary recovery.
Em 30 days, 60,9% Of the patients in the AORP group, 10% were continent. In the traditional technique group, the rate was 10%. 42%.
There was also a lower rate of complications and greater nerve preservation, an important factor for sexual function. In the control oncologicalRegarding the central objective of cancer surgery, the two techniques have become equivalent, without compromising safety or functionality.
What could happen from now on in the SUS (Brazilian Public Health System)?
A AORP It emerges as a strategic alternative for locations with limited access to robotics. By using traditional materials and dispensing with expensive equipment, it can expand access to a more advanced surgical standard.
There is additional data in progress: a study with 5 years The follow-up study is in the final stages of publication and indicates identical oncological control between AORP and the traditional technique. Another study compares AORP and robotic prostatectomy in 252 patients, with 126 in each group, and it is in the presentation phase for publication.
In services of SUSThe technique emerges as a transformative possibility by combining surgical efficiency and practical feasibility.
Costs four times lower and impact on the training of surgeons.
Recent comparisons between AORP Robotic surgery and robotic procedures show similar hospital stays and equivalent functional recovery. The difference lies in the cost, which is almost the same. four times smaller, disregarding the acquisition of the robotic platform.
This benefit is significant for public hospitals with limited budgets and increasing demand. The technique can also strengthen the training of new surgeons by incorporating principles associated with robotics into open surgery.
AORP functions as a pedagogical bridge and can prepare professionals to work in different realities, including centers that will have robotics in the future.
A AORP shows that it is possible elevate open surgery prostate cancer With greater precision and functional recovery, without relying on robots or inaccessible investments. The technique was designed to maintain oncological safety and reduce postoperative impacts.
For SUSThis advancement could mean greater access to an advanced surgical standard, at a lower cost, with the potential to improve the skills of healthcare teams. This places Brazilian innovation at the center of a practical solution to technological inequality in healthcare.
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