Travel around the Web and you’ll see some amazing claims for robotic prostatectomy:
“minimizes blood loss and pain…is the #1 choice for localized prostate cancer…is rapidly being chosen by more men as well as their doctors worldwide….is the most advanced surgical option….faster recovery times…shorter hospital stays.�
But these claims don’t get at a key question: are men more satisfied with robot- assisted prostatectomy?
A Duke University Medical Center Prostate Center survey says NO, they are not.
Duke’s survey of several hundred patients shows that men who got robotic prostatectomy were about four times as likely to be dissatisfied with their treatment decision as men who choose open retropublic surgery.
The authors concluded that those patients “were more likely to be regretful and dissatisfied, possibly because of higher expectation of an ‘innovative’ procedure. We suggest that urologists carefully portray the risks and benefits of new technologies during preoperative counseling to minimize regret and maximize satisfaction.�
In a letter to the editor of that journal, two authors who call them “surgical nihilists� wrote:
“We feel that far too many patients with prostate cancer are treated more definitively than need to be to save the occasional patient from dying.� They suggest, from their our own studies at Henry Ford Hospital, “one needs to perform six radical prostatectomies to prevent one death from prostate cancer. Stated otherwise, five of six radical prostatectomies are either unnecessary or ineffective.�
Then they addressed robotic surgery hype:
"Some opinion leaders have decried the expansion of robotic surgery in the United States, even calling the way it was introduced ‘a black mark on urology’ and attributing this growth to venal marketing techniques. They do not deny the merits of robotic surgery but feel that the hype does not match reality. There is some truth to these observations: Robotic surgeons have increasingly created Web sites, and the information presented there can be uncontrolled, unedited, and unproven."
So let the buyer beware.
Five of six surgeries are "either unnecessary or ineffective?" Didn't the Swedish study indicate a far higher proportion - like 16 out of 17?
As someone who performs several robotic operations a week, let me point out a few of my opinions.
Robotic prostatectomy is not a substitute for watchful waiting.
Many men are treated for prostate cancer that may not die from it. Part of the problem is that it is difficult to figure out which patients need therapy the most. These overtreated patients include radiation and cryosurgery as well.
The main thing that needs to be stressed is that a robotic prostatectomy is still a major surgery with similar complications to open surgery.
I do feel that these complications occur to a lesser degree in experienced hands.