Dr Frank Gardiner

USANZ 2017 – Dr Frank Gardiner

Professor Robert Alexander (‘Frank’) Gardiner AM is an academic urologist with the University of Queensland Centre for Clinical Research at Royal Brisbane & Women’s Hospital where he is appointed as Consultant Urologist.

Professor Frank Gardiner shares his insights into the trials & tribulations of robotic surgery trials.

Talking Urology podcast transcript

USANZ 2017 Interviews – Frank Gardiner

This is Talking Urology.

Joseph Ischia: I’m Talking Urology with Frank Gardiner, Emeritus Professor at the University of Queensland, who has come in to give us some insights to Prokar’s most recent talk, the trials and tribulations of robotic surgery. They really outlined his 15 years in doing research. One of the things that’s been raised is people are saying, well it’s very hard to do surgical trials, should we just abandon them?

Dr. Frank Gardiner: Joseph, they are hard to do and they often take a long time to complete. But we should identify the things that really are important and we should address them. And we should address them as rigorously as we can and that means randomized controlled trials because that is the way we will obtain the truth about things, and it’s a truth that matters.

Joseph: Absolutely. So, what do you think is the impact of all this discussion around the advantages of the robot? What are the disadvantages of the robot?

Frank: The robot is wonderful technology, it’s undeniable. Certainly, our 12 weeks results did not show an advantage in terms of the primary outcomes although there were some differences in secondary outcomes. But these were not as pronounced that people might like to say. The other thing that didn’t make me very cross was the inference that the robotic surgeon was inexperienced because he was anything but inexperienced, and as his contemporary is now in this country, he’s an outstanding surgeon robotically, as John Yaxley is, in terms of open surgery. In fact, he worked for two years with Deep Patel in North America in an intense robotic program, thereafter 12 months in the UK doing laparoscopic work, did 200 at Royal Brisbane before he started. And when you look at the published literature, there was a paper last year by Oberlin et al., and 41% of robotic prostatectomies in the US were done by high-value surgeons, so risks were not. So, by any stretch of the imagination he was experienced and we know he was good, so that is a furphy.

Joseph: So, what are the broader implications of the robot debate though?

Frank: The broader implications relate to whether it’s something that we should embrace instead of open surgery. My concern is that it’s silly to try to replace open surgery. I think that based on that 12-week data, and indeed our longer term data may be different because we have an open mind, but based on their 12-week data, could see excellence of the surgeon that matters. And this has bigger ramifications because in remote areas we need a urologist who can do trauma surgery and if they’re just robotic surgeons they will be less able to do that, I would contend. The other thing is if we endorse, unilaterally, robotic surgery and we find that the evidence is equivocal, what we are saying to third world countries is that they must follow us and that has a devastating effect for health budgets worldwide. And I think this is something we have to bear in mind in terms of getting overawed with one technology or another, it doesn’t just apply to robotic surgery.

Joseph: Excellent! Thank you very much, Frank. It has been wonderful chatting to you today.

Frank: Always nice to talk to you, Joseph. Thank you.

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