Men tend to like shiny new machines. And that may partly explain the growing popularity of robot-assisted surgery for treating prostate cancer.
But a new study, released this week, has found that the state-of-the-art robotic procedure really isn't substantially better than the old-fashioned method for removing the male gland when it has become cancerous.
Researchers at Memorial Sloan-Kettering Cancer Center in New York looked at the outcomes of 6,000 men who had their prostates removed through a variety of different surgical techniques.
Some patients had a traditional open radical prostatectomy, in which the surgeon makes a six-inch-long cut through the abdomen to gain access to the walnut-sized gland.
Others had the newer laparoscopic radical prostatectomy, in which extra-long medical instruments – including a camera scope – are inserted into the belly through small keyhole incisions.
And for a subset of the laparoscopic patients, surgeons also used the latest robotic instruments, which are remotely controlled by way of a 3-D visual system.
Despite all the hoopla regarding laparoscopic surgery – with or without robotic assistance – the study found few significant differences in outcomes. Patients tended to bleed less and recover faster with the keyhole surgery. But in terms of postoperative complications within a year of the surgery – including incontinence resulting from tissue damage – the level of risk appears to be equal with the different procedures. (The current study did not evaluate the risk of impotence or erectile dysfunction because it usually takes more than a year to determine if there is permanent damage. Research on this question continues. )
But the newest procedure is certainly more expensive. The robotic equipment – called the da Vinci Surgical System – costs about $4.5-million. The surgical instruments must be changed frequently, adding between $3,000 and $5,000 to the cost of each procedure.
William Lowrance, the lead author of the study published in the Journal of Urology, noted that many U.S. medical institutions have been heavily promoting their high-tech procedures – especially the use of robotic-assisted instruments. Numerous Canadian hospitals have also acquired the equipment and now some men won't agree to the surgery unless it's done robotically.
In an editorial accompanying the study, Yair Lotan of the University of Texas Southwestern Medical Center in Dallas, writes that the major factor affecting the success of any operation is the skill of the surgeon. Studies have repeatedly shown that surgeons improve with experience.
"I think the misconception is that the robot somehow makes you a better surgeon – it really doesn't," Dr. Lotan said in an interview. The robotic instruments may provide greater flexibility of movement, but they still have to be guided by the surgeon's hands, he added.