That's not strictly accurate Paul A. Research data published over recent years (including a large scale piece of research published in 2017 and reported widely in the press) shows that:
- open RP has slightly better outcomes in terms of 5 year and 10 year recurrence
- open is slightly less likely to lead to adjuvant or salvage RT
- open RP is slightly less likely to result in positive margins
- open RP is slightly less likely to leave a man impotent or with permanent ED
- open usually needs less time under general anaesthetic
- keyhole is less likely to end up with blood transfusion
- keyhole needs less time in hospital
- keyhole can mean being able to return to work quicker
- hospitals that have invested in Da Vinci machines need to use them to justify the cost of the machine + training for all the surgeons.
The debate between the two methods comes down in the end to medical outcomes v speed of recovery and economics. Given the choice of all methods, each man needs to decide what is most important to him - to be in hospital for only a couple of days and back to work quickly OR to have the best chance of a successful outcome. The ideal would be for each man to understand the possible impact of all RP methods and then make an informed choice between them; the problem increasingly is that men are only being offered robotic or keyhole and are misled into believing that it is 'the best'.
In addition, there are some men who cannot have keyhole due to heart problems, higher than average risk factors for general anaesthetic, scarring from previous abdominal surgery or other reasons. In my husband's case, the surgeon (one of the so-called 'gold tops' for Da Vinci) advised that because of suspect lymphs, existing scars and the position of the gland, he felt open would give him the best chance of a) getting it all and b) preserving some nerve bundles. Put that way, the inconvenience of being off work for 12 weeks seemed rather a minor issue.