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Robotic Surgery: Not Necessarily Better

Excerpts and Highlights from New York Times article:

Results Unproven, Robotic Surgery Wins Converts

New York Times, Feb 14, 2010

Gina Kolata

Today patients want robotic surgery for prostate removal, instead of the “old-fashioned” surgery in which the surgeon uses his hands. 

 One large national study, which compared outcomes among Medicare patients, indicated that surgery with a robot might lead to fewer in-hospital complications, but it might also lead to more impotence and incontinence. It is also not known whether robot-assisted surgery gives better or worse or equivalent long-term cancer control than the traditional methods, either with a four-inch incision or with a laparoscope.

 There is a lot of marketing hype. Once a hospital invests in a robot — $1.39 million for the machine and $140,000 a year for service contract, according to Intuitive Surgical (the robot’s maker) – it has incentive to use it.  Doctors and patients become passionate advocates, assuming that newer means better. 

 A robot’s ability to reach into small spaces comes with tradeoffs.  Ordinarily, doctors can feel how forcefully they are grabbing tissue, how well they are cutting, how their stitches are holding.  With the robot, that is lost.  And the robot is slow; it typically takes three and a half hours for a prostate operation, according to Intuitive, twice as long as traditional surgery.

 One study done by Dr. Jim C. Hu of Brigham and Women’s Hospital compared surgery with four-inch incisions to laparoscopic surgery, many with a robot.  The paper found that laparoscopic surgery patients had shorter hospital stays, lower transfusion rates and fewer respiratory and surgical complications.  But they also had more incontinence and impotence.

 The message for patients is not to assume that newer is better.  Measures like the number of operations a surgeon has done still matter a lot.

 The battle is lost.  Marketing is driving the case here.


However, when diagnosed with prostate cancer, keep in mind that surgery is not the “gold standard” for treatment anymore.  Chicago Prostate Cancer Center specializes in brachytherapy, or radioactive seed implant, which is just as effective as surgery in low-risk prostate cancer patients.  In addition, brachytherapy is a one-day, outpatient procedure with minimal recovery time (1-2 days) and minimal side effects.

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