Robotic surgeries costlier but safer

Patients who undergo robot-assisted surgeries on the kidneys or prostate have shorter hospital stays, a lower risk of blood transfusion or death - and a significantly higher bill compared to those who get older surgical procedures, a new study finds.

The analysis compared robotic surgery with standard laparoscopic or open surgeries and found that direct costs can run up to several thousands higher for the robotic procedures.

But the study wasn't able to gauge less obvious measures of effectiveness, such as whether quality of life over the long run is harmed or improved by one type of surgery or another.

"The value of this study is it documents there are some advantages" to robotic surgery, said Dr David Penson, a surgeon at Vanderbilt University Medical Center who was not involved in the work. "But we should have done this years ago," he said. "I think there was excitement in the general population and there was a lot of marketing about robotic surgery ahead of any proven benefit to the procedure," he said.

That robotic surgeries are costlier is also well known. Not only is the equipment expensive, but surgeons must invest time to learn how to use it.

Robotic surgeries and extra cost

To see if that extra cost comes with any benefits over either standard laparoscopic or open surgeries, Dr. Jim Hu at Brigham and Women's Hospital in Boston and his colleagues analysed surgery data from a national government database.

"It's timely because of spiralling healthcare costs, and one needs to look more closely at comparative effectiveness to justify the cost of these procedures," Dr Hu said.

His team decided to focus on urologic surgeries because that's the field that has adopted robotic surgery most rapidly, he said.

What the team found

During the last three months of 2008 - the most recent data available that allowed a comparison among the three approaches - more than half of all prostatectomies involved a robot, the team found. About 3% of patients underwent standard laparoscopic surgery and 44% underwent open surgery.

Open and laparoscopic surgeries were still more common than robotic surgeries for kidney surgeries.

Among the prostatectomy cases, there were no deaths from laparoscopic or robotic surgery, whereas two out of every thousand men died after the open procedure.

Also, about 5% of men who had open surgery needed a blood transfusion, compared to less than 2% of men who had robot-assisted surgery. The open-surgery group also stayed in the hospital about one day longer than the robotic group.

The outcomes were similar for people who had nephrectomy.

"I think the take home message is that robotic, looking at our study, had certain beneficial outcomes compared to open and laparoscopic procedures," said Dr. Hu.

The trade-off for those benefits can be found in the bill.

Benefits of robotic surgery

Dr. Penson, who wrote an editorial published with the study online in The Journal of Urology, said the benefits of robotic surgery are smaller than had been expected.

"Years ago, this was thought to be the be-all-end-all operation, particularly with prostate surgery. We were going to get patients out of the hospital quicker, have better potency and incontinence outcomes," he said.

"And the reality of it is that we climbed the mountain, relearned to do this operation, and there are some benefits, but not as much as we had hoped," he added.

Dr. Penson said the study was well done, but lacked some valuable measures, such postoperative sexual function and urinary continence.

He also said that because of the added costs of robotic surgery, studies like this should be done as soon as the technology becomes available, rather than a decade later.

"Ultimately, we have to generate comparative effectiveness (studies), because ultimately patients will have to pay more for their healthcare," Dr. Penson said. "And they will want to know if it's worth it."  - (Reuters Health, March 2012)

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