Robotic Prostate Surgery

New robotic prostate surgery not necessarily better By Julie Steenhuysen Tue Oct 13, 6:41 pm ET

CHICAGO (Reuters) – Men who have less invasive prostate cancer surgery -- often done robotically -- are more likely to be incontinent and have erectile dysfunction than men who have conventional open surgery, U.S. researchers said on Tuesday.

Many men, especially those who are wealthy and highly educated, favor minimally invasive surgery because they assume the high-tech approach will yield better results, but the evidence on that is mixed, the team reported in the Journal of the American Medical Association.

"We found men undergoing minimally invasive versus open surgery were more likely to have a diagnosis of incontinence and erectile dysfunction," Dr. Jim Hu of Brigham and Women's Hospital in Boston said in a telephone briefing. Hu said use of minimally invasive surgery has taken off since the introduction and heavy marketing of robot-assisted surgery, such as the da Vinci system made by Intuitive Surgical Inc.

The system consists of robotic arms, controlled from a console, that allow surgeons to perform less invasive surgeries. Hospitals advertise the systems as being able to reduce trauma, blood loss, risk of infection, scarring and often pain.

Hu said so far, there have been few studies that compare minimally invasive surgery with open surgery.

To do that, he and colleagues used billing data from the Medicare insurance program for the elderly on procedures done from 2003 to 2007. During that time, use of minimally invasive surgery for prostate cancer increased fivefold.

While both approaches fared equally well as a cancer treatment, they found that men who got the minimally invasive approach had shorter hospital stays, were less likely to need blood transfusions, and had fewer breathing problems after surgery than those who got conventional surgery.

But they were also more likely to have complications involving the genital and urinary organs, and they were more often diagnosed as having incontinence and erectile dysfunction than men who got open surgery.

The researchers also noted that fewer black and Hispanic men had the minimally invasive surgery, while Asians were much more likely to get the high-tech surgery.


Men who got the minimally invasive surgery were far more likely to live in areas with at least 90 percent high school graduation rates and median income of at least $60,000.

The fact that highly educated, wealthier men favored the higher technology alternative "despite insufficient data demonstrating superiority" may reflect a healthcare system "enamored with new technology" that increases health costs without offering clear benefits, Hu and colleagues wrote.

Ryan Rhodes, marketing director for Intuitive Surgical, disputed the findings.

"There have been over 800 papers published in peer reviewed journals talking about the outcomes of radical prostatectomy. The majority of these were favorable," Rhodes said.

He said the current study used Medicare billing data, which does not distinguish between robot-assisted and other types of minimally invasive prostate surgery.

"Looking at the data, you cannot accurately assess which patients were operated on robotically," he said.

Dr. Herbert Lepor of New York University's Langone Medical Center analyzed several studies on robotic-assisted prostate surgery in a paper published this year in Reviews in Urology. He said so far the evidence does not suggest the robotic procedure is superior to open surgery.

Lepor, who was not involved in the study, estimates that about 80 percent of minimally invasive prostate cancer surgery is done robotically. "What drives this is the industry creating the need," he said.

"We've increased the cost of care with the robot," he said. "Now what we are learning is continence and potency seem to be inferior."