04 October 2010

Robot-assisted surgery - pros, cons and other issues

Men with a new diagnosis of prostate cancer face a dizzying array of treatment options; everything from watchful waiting (or as some doctors prefer to call it, active surveillance) to robot-assisted prostatectomy. Since there are no perfect or well designed studies yet to help guide the decision making about robot-assisted operations, very often the preferences or biases of the medical specialist to whom the patient is referred will influence the option chosen. Clearly, the train has left the station when it comes to the tools that U.S. surgeons prefer for removing prostate glands since nearly 90 per cent of all prostate removal operations are done using robots, even without solid evidence for long term benefits.

In Canada, robotic procedures are less common but there are still about 11 robots in half a dozen hospitals, including one in B.C. - at Vancouver General Hospital. There are lots of robot converts among patients and doctors here too.

But newer is not necessarily better and there is a pressing need for comparative studies. Previous stories on robotic prostatectomies have reported on the fact that surgeons like the robots because they are so much more ergonomic and they offer short term benefits like less blood loss and faster recoveries. Still, there are no studies yet showing better or worse long term outcomes (residual cancer and/or recurrences). As an aside, we have not found anything about surgeons who switch back to conventional operative techniques, after they've become adept using robots. Experience and skill count for everything when you're a surgeon. The more experience a surgeon has, the better his or her patient outcomes (survival, complications, quality of life) will be. And studies have shown that surgeons need to do at least a few hundred procedures to become highly adept on the robot. So if the volume of procedures is reduced because of higher costs, then such surgeons will not gain the necessary experience. Secondly, no one can do any kind of comparative study if there aren't enough patients in each study group. In order to have statistical power, studies need thousands of subjects.

There are some hopeful signs that Americans will be leading the way in doing some of the research that needs to be done as you will see if you read this press release I got from the American Urological Association on a new piece of legislation meant to help the war on prostate cancer.



NOTE: Issues on this site regarding prostate cancer and treatment options, are provided for information only, and are not meant to substitute for the advice of your own physician or other medical professional. Prostate-Report.org does not endorse any specific product, service or treatment.





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