Indian Express
15 February, 2010
Gina Kolata
New York, USA

One in six American men develop prostate cancer, making the costlier robot–assisted surgery big business
DR JEFFREY A Cadeddu, of the University of Texas Southwestern Medical Center, was trained to take out cancerous prostates thetraditionallaparoscopicway:making small incisions in the abdomen and inserting tools with his own hands to slice out the organ. But, patient after patient was walking away. They wanted surgery by a robot, controlled by a physician not necessarily in the operating room, face buried in a console, working the robot’s arms with remote controls.

A robot’s slender arms can reach places human hands cannot. But ro bot–assisted prostate surgery costs more –– about $1,500 to $2,000 more.

f And it is not clear whether its out– comes are better. It is also not known s whether robot–assisted prostate s surgery gives better cancer control ei ther with a four–inch incision or with – smaller incisions and a laparoscope.

One large study, indicated surgery t witharobotmightleadtofewerin–hospiy talcomplications,butitmightalsoleadto t more impotence and incontinence. But the study included conventional las paroscopypatientsamongoneswhohad robot–assistedsurgery,makingitdifficult toassessitsconclusions. Meanwhile, hospitals and surgeons are marketing their services. Last year, 73,000 American men – 86 per cent of the 85,000 who had prostate cancer surgery – had robot–assisted operations, claim the robot’s maker, Intuitive Surgical, the only official source of such data.

With prostate cancer, more is at stake, said Dr Jason D Engel, director of urologic robotic surgery at George Washington University Medical Center. One in six American men develop prostate cancer. Treatment options include radiation and watchful waiting, but the most popular is surgery. “With the stream of prostate cancer patients that come through,” Dr Engel said, “this is a big, big business.”

Dr Michael J Barry, a professor of medicine at Massachusetts General Hospital,saidthatonceahospitalinvests in a robot –– $1.39 million for the machineand$140,000ayearfortheservice contract–– ithasanincentivetouseit.

The robot’s ability to reach into small spaces comes with tradeoffs.

Originally, doctors can feel how forcefully they are grabbing tissue, how they are cutting, how their stitches are holding. With the robot, this is lost. And the robot is slow; it typically takes threeand–a–half hours for a prostate operation, says Intuitive.