HAS ROBOTIC SURGERY TAKEN ITS TOLL?
Has Robotic surgery taking its toll?
By Rajeen
21st March 2012
There have been many recent articles on the efficacy of robotics on their long term results, and the controversies surrounding them
It is best that each individual read the following links, and decide on their own. It looks like the hype and excitement over robotics is soon taking its toll. Below the links are also various statements made by different authors and experts over the past year, including one from John Hopkins. We have to be realistic, and individually analyze the data.
The links are:
The following are various statements made over this issue over the course of the past year:
1. Even though robot-assisted laparoscopic prostatectomy (RALP) is now much more common than open radical prostatectomy as a surgical treatment for men with clinically localized prostate cancer, there are in fact no data to suggest that post-surgical continence or sexual function are any better after RALP than they are after open surgery.
2. There is lack of any evidence that men who are treated with robot-assisted laparoscopic prostatectomy (RALP) will have better outcomes with respect to continence and sexual function than men who elect to have open radical prostatectomy.
3. There are short-term benefits associated with RALP as compared to open surgery. These include: a reduction in risk for blood loss and for resultant blood transfusion during surgery; less post-operative pain; and a shorter postoperative recovery time. However, many men are under the mistaken illusion that RALP is also associated with a higher probability of complete continence and better sexual function than open surgery.
4. The skill levels of individual surgeons are much more likely to be a key factor in such outcomes than the technology used to carry out the surgery
5. Comparative data on outcomes using different surgical techniques are limited; one population-based observational cohort study using U.S. Surveillance, Epidemiology, and End Results (SEER) and Medicare linked data found that minimally invasive/robotic radical prostatectomy for prostate cancer was associated with higher risks for genitourinary complications, incontinence, and erectile dysfunction than open radical prostatectomy (Hu JC, Gu X, Lipsitz SR, Barry MJ, D’Amico AV, et al. Comparative effectiveness of minimally invasive vs open radical prostatectomy. JAMA. 2009;302:1557-64)
6. There absolutely are some benefits to the use of RALP as compared to open surgery for treatment of localized prostate cancer. These are primarily those of less blood loss during surgery, a shorter hospital stay, faster post-surgical recovery, and less need for post-surgical pain management.
It should also be noted that these benefits actually have nothing to do with the use of the da Vinci robot; they are also found through the use of standard forms of non-robot-assisted laparoscopic radical prostatectomy (LRP). However, there are absolutely no data whatsoever to suggest that RALP is “better” or “safer” that open surgery or LRP in terms of such outcomes as excision of the cancer, the risk for positive surgical margins, post-surgical continence, or recovery of erectile function.
7. The da Vinci robot is a technologically sophisticated surgical tool. Once a surgeon has learned to take advantage of its capabilities (which may require as many as 250 or more procedures), it certainly facilitates the surgical conduct of a high-quality radical prostatectomy for some surgeons — but that is not the same as improving surgical outcomes.
8. There are no randomized, controlled studies showing patient benefit in robotic surgery. “New doesn’t always mean better.” Robotic surgeries take more time, keep patients under anesthesia longer and are more costly.
9. There is little doubt that hospitals have been inappropriately promoting the benefits of RALP as compared to other forms of treatment for prostate cancer, and we further suspect that this inappropriate promotion has led to many men having RALP as a treatment for their prostate cancer that may have been either unnecessary or inappropriate because they had unrealistic expectations about the outcome of their treatment by this method. The quality of outcome after radical prostatectomy has little to do with the technology being used and everything to do with the skill, expertise, and focus of the individual surgeon who does the operation.
Rgds
Dr Rajeentheran Suntheralingam
21st March 2012Source:
HAS ROBOTIC SURGERY TAKEN ITS TOLL?
