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Study raises concerns about robotic prostate surgery

E-mail | Print | Comments () Posted by Gideon Gil October 13, 2009 04:19 PM

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By Liz Kowalczyk, Globe Staff

Many hospitals have been widely advertising robot-assisted surgery, especially for prostate cancer, marketing it as having shorter recovery times and fewer complications than standard operations.

But a nationwide study published today raises serious concerns about the wide use of robots in prostate operations, say Boston physicians who led the research team.

The Harvard Medical School researchers found that cancer patients who underwent minimally-invasive prostate removal -- now usually done with remote-controlled robots -- were more than twice as likely to experience incontinence or impotence a year and a half after their operations than patients who had traditional surgery using an open incision.

Success at controlling the cancer was about the same for both operations. Patients who had minimally invasive, or laparoscopic, surgery were able to go home from the hospital in two days on average, one day shorter than the comparision group, and had fewer post-surgery respiratory problems and other short-term complications.

Dr. Jim Hu, a urological surgeon at Brigham and Women's Hospital and the study's lead author, said the results show how direct-to-consumer marketing can lead to the explosion of an expensive new treatment -- even when little evidence exists to support the therapy's superiority over standard care.

The government data Hu and his colleagues used for the study did not distinguish between minimally-invasive surgery with a robot and without a robot. But robot-assisted prostatectomy has grown rapidly this decade.

It accounted for just 1 percent of all radical prostatectomies in 2001; by 2006, the number had jumped to 40 percent. Today, California-based Intuitive Surgical, which makes the da Vinci robot, estimates that its technology is used in more than 70 percent of the procedures.

"Once hospitals have made that multi-million dollar commitment of buying a robot, they want to market it,'' Hu said. And patients, he added, are particularly receptive to advertising of minimally-invasive robotic surgery. "Patients intuitively perceive minimally-invasive procedures to be better because of the new technology and the wow factor that goes into it.''

As patients flocked to hospitals with robots, surgeons at competing institutions have lobbied their hospitals to buy the da Vinci.

However, Ryan Rhodes, an Intuitive spokesman, called today's study misleading because it did not use patient surveys, which he said are the most reliable indicator of whether a patient suffers from post-surgical erectile dysfunction or incontinence. Rhodes also criticized the study because of the uncertainty over how many of the minimally-invasive cases involved a robot. He said the da Vinci was not in as wide use in the early years of the study.

The study, published in the Journal of the American Medical Association, reviewed Medicare claims data for 8,837 men over age 65 who had radical prostatectomies between 2003 and 2007, in one of the largest multi-center studies yet on a much-debated area of medicine.

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About white coat notes

White Coat Notes covers the latest from the health care industry, hospitals, doctors offices, labs, insurers, and the corridors of government. Chelsea Conaboy previously covered health care for The Philadelphia Inquirer. Write her at cconaboy@boston.com. Follow her on Twitter: @cconaboy.

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