Surgery’s pre-painkiller, pre-antiseptic past and its robotic future

Nice talk for lay-people. Surprised she didn’t speak of remote surgery. In the future, I believe we will have the best surgeons sit in a comfortable room somewhere, NY, LA, Bangalore, Shanghai, etc., and operate upon patients far away. Have a physician extender place the ports and a surgeon can operate in an assembly line fashion. Good for patients, doctors, and third party payors.

I am the wife of a prostate cancer survivor who writes a blog for a nonprofit called, “Living with Prostate Cancer” (prostatecancerblog.net).

I am a big fan of yours and am disappointed that you only chose to present one side of this story. Robotically assisted (laparscopic) prostatectomy (RALP) has not shown itself to be superior to traditional open surgery (RRP) in areas where it truly matters, even though RALP has been marketed to doctors and patients alike as the holy grail. With the robot, you might get out of the hospital a day or two earlier or have less blood loss and a smaller scar. BUT…

RALP often produces inferior results to RRP when it comes to cancer control (only thing that really matters to me) and quality-of-life issues:

*Oncological outcomes*. The rate of post-surgical positive margins was higher in doctors who used RALP vs. open surgery, according to a study done by Dr. Hu or Harvard (See notes below). The only RALP docs whose numbers approached or equalled those of the open surgeons were a select few *extremely experienced* minimally invasive surgeons who worked at “centers of excellence”. The vast majority of prostate cancer patients would not have access to these doctors anyway.

Side-effects of treatment. Robotically assisted prostate surgery did not reduce the risk of or severity of post-prostatectomy erectile dysfunction among men who were treated with it. And “urinary quality of life” issues after RALP (vs RRP) were actually said to be worse.

RALP is, unfortunately, not a leap forward in the treatment of prostate cancer but, as GU oncologist Dr. Michael Glode wrote in his blog, “All Things Prostate” (rejuvenationhealth.com), it is simply a “lateral” move. That’s not good enough for us patients. We need treatments that will save more lives with fewer debilitating side effects.

Leah F. Cohen

prostatecancerblog.net
A project of Malecare

[Sources: "Study Finds Minimally Invasive Surgery Lacking," NYT, 5/27/008, http://prostatecancerblog.net/?p=391; "Dr Glode: Reality and the Robot", 8.9/08,] http://prostatecancerblog.net/?p=469,