I am including an excerpt from a blog post written by Dr. Michael Glode, an experienced genitourinary oncologist. I highly recommend his site because what you get from Dr. Glode is straight talk.
Dr. Glode writes that he’s had reservations about robotic prostate surgery for a long time. He acknowledges that it is now seen by urologists as the way of the future, but he questions whether it is really superior to old-fashioned open surgery. Dr. Glode doesn’t believe it is. His points out that robotic surgery is just a different method for achieving the same result. He also alludes to a recent New York Times article which found that patients who’ve had robotic surgery express more regrets than those who’ve had the old-fashioned kind:
“Now a new article has appeared which confirms all the same things. Unrealistic hopes for outcomes that simply aren’t any better in any study lead to more disappointment among patients. I wish it wasn’t the case, but I told you so…. Sometimes technology leads to terrific advances. At other times, it is simply a new way of doing the same old thing with different tools. You can use a hand wrench or an air powered wrench to tighten the lug nuts on your car’s wheels. Either way the wheel should stay on if done correctly. It won’t stay on any better with one versus the other. BUT…a great mechanic using either one might notice that nail in the tire that hasn’t yet caused a flat tire.”
I think Dr. Glode has a point.
I really hate to criticize robotic surgery. I have always tried to focus on the positive. And people squeal when you even question this “sacred cow.” Naturally, patients want to think they got superior treatment, and most recent PC surgery patients have had robotic surgery.
I think it’s important to point out the deficits of robotic surgery because some doctors (and patients) make this treatment out to be the holy grail, which it isn’t. The problem is that if you believe you have found the holy grail, *you will stop looking for it*. We can’t afford to do that.
The truth is that robotic surgery still leaves a significant number of men with incontinency and impotency problems, among others. This is true even with nerve-sparing. And the oncological outcomes (success in getting rid of the cancer) are worse with robotic surgery than with with the old-fashioned kind (see my post, “Mayo Clinic”, etc.) *unless the robotic RP is done by a member of a small coterie of very, very experienced surgeons — think 500-1,000 surgeries.
What would represent a true miracle in the (surgical) treatment of prostate cancer would be a therapy that *improves cancer outcomes without causing side effects that significantly impact quality of life in a negative way.* Unfortunately, robotic surgery is not the answer. And we will only get better therapies if we fight for them.
There was an article in the New York Times recently which stated that men who’ve had robotic vs. open prostatectomy express more regrets. I don’t think this is because robotic is a worse treatment, but that it is often presented to patients in an unrealistic, overly optimistic way. For example, I recently read the published results for robotic PC surgery by a prominent surgeon, and he stated that the potency rate for his post-surgical RP patients was “up to 97%”. Not sure what that even means, but I can tell you those stratospheric results are unrealistic.
Finally, there’s a problem with the skill of many (probably the majority) of the surgeons who are performing robotic RP. This method of surgery has grown astronomically in recent years, as was recently reported on the cover of Barron’s magazine in an article about the rise of Intuitive Surgical Co., maker of the da Vinci robot. The article pointed out that most surgeons who perform robotic surgery are “late adaptors”, which is a fancy way of saying they only acquired the machinery recently. The article also stated that the vast majority of surgeons who perform robotic RP’s do very few of them on a regular basis. Apparently, the “learning curve” for robotic surgery is very, very steep, and the bad news for patients is that most robotic surgeons aren’t there yet.