Is Minimally invasive prostate surgery riskier?

Interesting article in Medical News Today about possible complications surrounding robotically assisted prostate surgery and whether despite the fact that it offers patients improved short term recovery, it can actually create long term genitourinary complications. It would bhe interesting to hear further reaction from medical professional about this-Intuitive Surgical the key player in robotically assisted surgery has already come back to say that in 800 previous studies on robot-assisted prostate surgery, the overwhelming majority have shown superior results, while other medics have advised that the Medicare billing codes used to extrapolate data for the study don't necessarily reflect between robotically-assisted and other forms of MIRP.

Thoughts and views on this would be welcome- highlights and link to the full article below:

While it is accepted that minimally invasive surgery cuts post operative recovery time and shortens hospital stays, research from the US has highlighted the possiblity of complications for patients following minimally invasive procedures to treat prostate surgery. These possible complications include erectile disfunction and incontinence.

The research was the work of Dr Jim C Hu, from the division of Urolic surgery and the Center for Surgery and Public Health at Bringham and women's hospital Boston.

The research suggests that there has been a rapid rise in minimally invasive radical prostectomy (MIRP), particularly robot assisted procedures, from 1% of all radical prostectomies in 2001 to 40% in 2006, and this despite the lack of data on outcomes when compared with open retropublic radical prostectomy (RRP), the more conventional prostate treatment.

For the study, Dr Hu and his team assessed the surgical outcomes of MIRP versus RRP in nearly 9000 men with prostate cancer, nearly 2000 of the men had MIRP, the others had RRP. The data they used came from US Surveillance, epidemiology, and end results medicare-linked data.

Results showed that over the study period, MIRP use went up by nearly five fold, from 9.2 % in 2003 to 43.2 % iin 2006-7. The study found that short term, MIRP offered good patient benefits such as shorter hospital stays, lower risk of postoperative respiratory complications, lower risk of miscellaneous surgical complications and lower likelihood of needing blood transfusions, while long term, men undergoing MIRP vs RRP experienced more genitourinary complications 4.7 % vs 2.1% and were more often diagnosed as having incontinence and erectile disfunction.

For full details of this story see http://medicalnewstoday.com/printerfriendlynews.php?newsid=167322


CMR wonders if there is a danger of confusing the robotic-assisted prostatectomies, other procedures included under 'minimally invasive radical prostatectomy', and surgical techniques, such as 'nerve-sparing' surgery designed to minimize erectile problems and other-post surgical complications?The preponderance of scientific evidence to this point suggests that robotic-assisted surgery does have financial advantages to the hospital/clinic/physicians' practice using it, i.e. less blood loss, shorter recuperations, fewer post-surgical clinical complications, all designed to facilitate faster patient movement through the operating suite to maximize revenue. While these advantages suggest a benefit to the patient as well, it seems that more study is indicated on the incidence of two specific complications and their psycho-social, as well as economic, implications for the patient's ultimate satisfaction with the procedure.