Wednesday, January 2, 2013

Robot Prostatectomy Cuts Incontinence, Surgeon Finds


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."
Eur Urol 2012.

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