Forum for Science, Industry and Business

Sponsored by:     3M 
Search our Site:

 

Robot-assisted prostate surgery has possible benefits, high cost

30.08.2005


Although minimally invasive prostate removal aided by a robot can lead to less blood loss, shorter hospital stays and fewer complications, there is no evidence that the procedure improves cure rates, according to a new technology assessment.

In addition, robotic surgery, in high demand among patients, can lose money for hospitals because of its expense and special training required, according to the new review of studies by ECRI.

ECRI is a nonprofit health services research agency that produces systematic evidence reviews on medical devices, drugs, biotechnologies, procedures and behavioral health services.

The review of 625 cases looks at two studies that compared the three procedures available to patients: traditional open surgery, laparoscopic (also known as minimally invasive) surgery and robotic-assisted laparoscopic surgery.

In the review, average blood loss was significantly lower for patients who underwent either of the two minimally invasive procedures: less than 150 ml for robotic-assisted and 382 ml for non-robotic, while the average blood loss for open radical surgery in the two studies was 418 ml and 910 ml.

Cancer cure rate, measured by presence of cancerous cells at the surface of the removed prostate, and by PSA levels following surgery, was nearly identical for all three procedures.

Hospital stay was significantly shorter with robotic-assisted prostatectomy compared to open surgery in both studies, 25.9 hours versus 52.8 hours in one study.

One study reported significant difference in catheterization time: 7 days for robotic-assisted patients, 7.9 days for non-robotic laparoscopy patients and 15.8 days for open surgery patients.

Open prostatectomy had a significantly higher overall complication rate of 15 percent, while non-robotic laparoscopic prostatectomy had a rate of 10 percent and robotic-assisted had a complication rate of 5 percent.

Prostate cancer patients’ biggest concerns -- after cure -- are the possible side effects of surgery, including urinary incontinence and sexual impotency. Data on these side effects from robotically assisted prostatectomy were sketchy at best, and no evidence was available to indicate that any surgical method emerged as better than another for these side effects.

So far, patient demand, not evidence, is the driving force behind the rise in robotic-assisted prostatectomy, according to report co-author Diane Robertson, director of Health Technology Assessment Services for ECRI.

Robertson says that the concept of minimally invasive surgery is highly attractive to patients, with many willing to travel for the robotic procedure, but she cautions that patients should choose based on surgeon experience and evidence on efficacy rather than just picking the latest technology.

"If you have to choose between someone who hasn’t performed many robotic surgeries and a person who has performed many open procedures -- take the open procedure," says Peter G. Schulam, M.D., Ph.D., a urology professor at the David Geffen School of Medicine at UCLA.

Schulam routinely performs non-robotic laparoscopy, the more technically difficult of the minimally invasive surgeries.

Michael Esposito, M.D., a surgeon in Hackensack, N.J., who has performed about 425 robot-assisted surgeries, explains, "Robotics is a modification tool that further refines laparoscopy." Esposito says that robotics offers a three-dimensional view with much greater clarity, made possible with a binocular telescope held by one of the robotic arms.

Robotics allows surgeons to work seated at a console a few feet away from the operating table, pushing a joystick and pressing foot controls to remotely manipulate the three robotic arms at the bedside.

One arm positions a high-resolution camera, while the other two arms control the surgical instruments. "Robotic [hands] are wristed instrument that can open, close, flex and rotate 170 degrees," Esposito says. "They’re so small and meticulous that you can scale movements and do extremely fine work."

Robotics is meant to eliminate hand tremors, but some surgeons find the lack of contact with instruments disconcerting. Esposito says that, once experienced with robotics, "your vision becomes a surrogate for tactile feedback."

Schulam says that both forms of minimally invasive surgery lead to shorter recovery and less pain "because there’s no stretching of muscle, and possibly, less blood loss." Also, "patients prefer the five smaller holes over a larger midline incision."

Cost was the one area in which the older open surgery was the clear winner: Open radical prostatectomy costs $487 less a case than non-robotic laparoscopy and $1,726 less than robot-assisted prostatectomy.

According to the review, "Shorter operative time and decreased hospital stays associated with the robotic procedure did not make up for the cost of the additional equipment expenditure." Estimated costs of the robotic system to a provider run about $1.2 million a year, with maintenance costs of $120,000 a year and one-time costs of $1,500 a case.

"Hospitals have to consider whether they can use the system for more than one type of procedure to make it worth the capital equipment investment, if the institute can use it for many applications," says Robertson. She adds that many operating rooms are not big enough to accommodate the robotic system.

Laurie Menyo | EurekAlert!
Further information:
http://www.hbns.org
http://www.ecri.org
http://www.cfah.org

More articles from Medical Engineering:

nachricht Artificial intelligence may help diagnose tuberculosis in remote areas
25.04.2017 | Radiological Society of North America

nachricht Pharmacoscpy: Next-Generation Microscopy
25.04.2017 | CeMM Forschungszentrum für Molekulare Medizin der Österreichischen Akademie der Wissenschaften

All articles from Medical Engineering >>>

The most recent press releases about innovation >>>

Die letzten 5 Focus-News des innovations-reports im Überblick:

Im Focus: Making lightweight construction suitable for series production

More and more automobile companies are focusing on body parts made of carbon fiber reinforced plastics (CFRP). However, manufacturing and repair costs must be further reduced in order to make CFRP more economical in use. Together with the Volkswagen AG and five other partners in the project HolQueSt 3D, the Laser Zentrum Hannover e.V. (LZH) has developed laser processes for the automatic trimming, drilling and repair of three-dimensional components.

Automated manufacturing processes are the basis for ultimately establishing the series production of CFRP components. In the project HolQueSt 3D, the LZH has...

Im Focus: Wonder material? Novel nanotube structure strengthens thin films for flexible electronics

Reflecting the structure of composites found in nature and the ancient world, researchers at the University of Illinois at Urbana-Champaign have synthesized thin carbon nanotube (CNT) textiles that exhibit both high electrical conductivity and a level of toughness that is about fifty times higher than copper films, currently used in electronics.

"The structural robustness of thin metal films has significant importance for the reliable operation of smart skin and flexible electronics including...

Im Focus: Deep inside Galaxy M87

The nearby, giant radio galaxy M87 hosts a supermassive black hole (BH) and is well-known for its bright jet dominating the spectrum over ten orders of magnitude in frequency. Due to its proximity, jet prominence, and the large black hole mass, M87 is the best laboratory for investigating the formation, acceleration, and collimation of relativistic jets. A research team led by Silke Britzen from the Max Planck Institute for Radio Astronomy in Bonn, Germany, has found strong indication for turbulent processes connecting the accretion disk and the jet of that galaxy providing insights into the longstanding problem of the origin of astrophysical jets.

Supermassive black holes form some of the most enigmatic phenomena in astrophysics. Their enormous energy output is supposed to be generated by the...

Im Focus: A Quantum Low Pass for Photons

Physicists in Garching observe novel quantum effect that limits the number of emitted photons.

The probability to find a certain number of photons inside a laser pulse usually corresponds to a classical distribution of independent events, the so-called...

Im Focus: Microprocessors based on a layer of just three atoms

Microprocessors based on atomically thin materials hold the promise of the evolution of traditional processors as well as new applications in the field of flexible electronics. Now, a TU Wien research team led by Thomas Müller has made a breakthrough in this field as part of an ongoing research project.

Two-dimensional materials, or 2D materials for short, are extremely versatile, although – or often more precisely because – they are made up of just one or a...

All Focus news of the innovation-report >>>

Anzeige

Anzeige

Event News

Expert meeting “Health Business Connect” will connect international medical technology companies

20.04.2017 | Event News

Wenn der Computer das Gehirn austrickst

18.04.2017 | Event News

7th International Conference on Crystalline Silicon Photovoltaics in Freiburg on April 3-5, 2017

03.04.2017 | Event News

 
Latest News

Scientist invents way to trigger artificial photosynthesis to clean air

26.04.2017 | Materials Sciences

Ammonium nitrogen input increases the synthesis of anticarcinogenic compounds in broccoli

26.04.2017 | Agricultural and Forestry Science

SwRI-led team discovers lull in Mars' giant impact history

26.04.2017 | Physics and Astronomy

VideoLinks
B2B-VideoLinks
More VideoLinks >>>