NEW YORK (Reuters Health) Aug 08
- Robot surgery for prostate cancer lowered the rate of urinary complications
compared with hands-on surgery in a new Italian study.
While the
study was small and contradicts earlier results, it's important because surgery
has quickly overtaken cheaper alternatives in the U.S., helped by hospitals aggressively
marketing the technology.
Yet there
is no ironclad science showing it's any better, and many doctors have voiced
concerns about the higher costs.
In the
randomized Italian study, a single surgeon performed laparoscopic radical
prostatectomy on 120 men, with or without the help of a robot.
He and
his colleagues found no reliable difference in blood loss, operating time,
length of hospital stay or cancer outcomes at one year.
However,
men reported less use of diapers after the robot procedure. At one year, for
example, 95% of the robot-assisted group used no or at most one safety diaper a
day, compared to 83% of the others.
Also, of
the men who were able to achieve an erection before their surgery and were
treated with nerve-sparing techniques, 80% in the robot group had recovered
that ability within a year vs just 54% in the control group.
"This
is certainly the strongest evidence to date (that) laparoscopic surgery done
with robotic assistance is going to yield better outcomes than traditional
laparoscopy," said Dr. Matthew Cooperberg, a urologist at the University
of California, San Francisco.
"Nobody
is saying this is definitive, but it is probably the best study we will get
answering this question."
According
to Dr. Cooperberg, few surgeons in the U.S. today offer laparoscopic surgery
without robot assistance, despite the lack of good evidence that using the
machine is better.
Dr.
Francesco Porpiglia of San Luigi Gonzaga Hospital in Turin, who did all the
surgeries in the study, did not respond to a request for comments.
But in
their report online July 20th in European Urology, he and his colleagues say
the better results with the robot could be due to higher surgical precision
given the 3D magnification and wide range of movement of the machine.
They also
recognize that their study is limited by the small number of men who
participated. Also, they caution, "Our results depend strictly on the
single surgeon and do not represent a real-life situation."
Dr.
Cooperberg, who uses the technology himself, said skill and experience are more
important than technology.
Perhaps
the strongest conclusion from the new report, Dr. Cooperberg said, is that
patients should not be afraid to ask surgeons about their outcomes. In that
vein, he added, "If you are going to see Dr. Porpiglia for prostatectomy,
definitely get the robot."
SOURCE: http://bit.ly/MwltHt
Eur Urol
2012.
