Treatments

Humans Beat Robots On Prostate Surgery Side Effects

Scan highway billboards, flick on your TV or listen very long to the radio and you'll probably come across an ad from a hospital touting robot-assisted surgery as the way to go for treating prostate cancer.

Prostate surgeon at robot console. i i

A surgeon hunches over the console of a surgical robot. Intuitive Surgical hide caption

itoggle caption Intuitive Surgical
Prostate surgeon at robot console.

A surgeon hunches over the console of a surgical robot.

Intuitive Surgical

The main selling point boils down to a promise of precision. An unflappable robot allows a surgeon to operate through tiny incisions and make such careful work of prostate removal that dreaded side effects—impotence and incontinence—are vastly reduced compared with a surgeon operating alone. Right? Wrong, say researchers who analyzed years of data on experience with the gee-whiz technology.

A study just published by JAMA suggests older men whose prostates were removed with a robot's help actually have greater chances of being impotent or incontinent than if they had the surgery done the relatively old-fashioned way. After adjusting for all sorts of factors, the researchers found a diagnosis of incontinence after surgery was 30 percent more likely in the robot group and impotence was 40 percent more likely.

Overall, genitourinary complications 30 days after surgery cropped up more than twice as often for robot-assisted surgery compared with traditional approaches—4.7 percent versus 2.1 percent. Although impotence and incontinence were diagnosed more frequently in men who had the robot surgery, procedures to treat those conditions were about the same in both groups.

In the robots' favor, length of hospital stay and transfusion rates were much lower when the machines were on the case. But those aren't the usual selling points of hospitals' ads.

The study has its limitations, of course. The researchers looked back in time at data from a cancer registry and Medicare billing data. Patients who got the minimally invasive robotic surgery tended to be richer and come from areas with higher levels of education.

Still, even after adjusting for all sorts of factors, the researchers found a diagnosis of incontinence after surgery was 30 percent more likely in the robot group and and impotence was 40 percent more likely over the long haul.

Robot surgery has already become very popular, the study showed, with more than 43 percent having the robotic approach by 2007 compared with 9.2 perent in 2003. "The tendency in Americans is to gravitate toward the latest technology," Otis Brawley, chief medical officer for the American Cancer Society, told Bloomberg. "This is not the first time that new technology has been evaluated and has more shortcomings than we actually thought."

The researcher found a blunt lesson in the data:

Our findings that men of higher socioeconomic status opted for a high-technology alternative despite insufficient data demonstrating superiority over an established gold standard may be a reflection of a society and health care system enamored with new technology that increased... costs but had yet to to uniformly realize marketed or potential benefits during early adoption.

Paul Levy CEO of Beth Israel Deaconess Hospital in Boston resisted joining the robot arms race for a while, invoking the absence of data to show the expensive robots helped patients much. In early 2007, he asked on his blog "Running a Hospital":

Do I spend over $1 million on a machine that has no proven incremental value for patients, so that our doctors can become adept at using it and stay up-to-date with the 'state of the art,' so that I can then spend more money marketing it, and so that I can protect profitable market share against similar moves by my competitors?

Fast forward to late 2008 and his answer was "Uncle!" How come? Well, practically every other top-tier hospital in Boston had one, so he had to keep up with the Joneses, no matter the expense.

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