There is an old saying which states that it is a poor plumberr that blames his tools.  As with any “art” which requires manual dexterity to perform, the skill and muscle memory of the practitioner will have a large influence on how the outcome will be.  Having helped a loved one make a decision on method and having read the JAMA study, I am familiar with all of the options and including robotic surgery. From my perspective the arguments for robotic surgery just made logical sense, whether or not there is data to substantiate the marketing.  First, the idea that you can physically remove the cancer tissue completely from the body, assuming the patient is physically healthy enough to undergo general anesthisia and surgery makes all the sense in the world. While radiation treatments have a very high rate of success, it just feels like you have a better chance of long term survival if the tumor has been removed. Also with surgery first, radiation treatment is still an option should the pathologist determine a need for it. With radiation first, the fusing of prostate to the surrounding tissue that occurs with treatment makes it next to impossible to perform a subsequent surgery should the radiation not produce remission.  Second, there is far less loss of blood than in a traditional open surgery. An added benefit is that with smaller incisions and less tissue damage, wound care is easier and should lead to fewer surgical site infections, so long as a sterile field is maintained and proper aftercare is performed. Thus healing is quicker and returning to normal activity levels can take place sooner.  Third, the surgeon gains the benefit of an improved magnification of vision as the console has 10x magnification and also greater control over instruments as the robot has a limiter on its movement so that for each movement the surgeon instructs the robot to make, the robot makes half that move, so it logically translates to twice the level of accuracy over the precision of the surgeons movements.  Fourth, while I am sure that stress and fatigue still come into play in the operating room, the thought that the surgeon does not have to physically hold the instruments seems to suggest that there would be less physical fatigue that would come into play in the results. I would assume that it would be a lot easier for the surgeon to freeze the instruments of the robot in order to flex his/her hands or stretch their necks or shoulders than if they were at the operating table holding the instruments in place.  It is difficult to say who is right. A tenent of the Scientific method is that experiments are repeatable. With something as complex as surgery, I think that even the most skilled and experienced surgeons would be hard pressed to exactly repeat each move they make during the surgery.  While the questions are important from a public health perspective, I think it is difficult for a person to not make this choice. There is more at stake that he ability to have an erection. Men should learn that sex and sexual satisfaction doesn’t necessarily require the use of a penis. Chosing erectile function over prolonged life expectancy with fewer surgical complications just seems crazy to me.
Robot-assisted prostate cancer surgery costs more, and it is not clear whether its outcomes are better, worse or the same.