Minimally Invasive Surgery May Pose Added Risks
Posted on: Tuesday, 13 October 2009, 12:00 CDT
A new study has shown that minimally invasive procedures, while intended to shorten hospital stays and lower the risk of other health complications, may increase the risk of other complications, such as incontinence and erectile dysfunction.
Writing in the October 14 Journal of the American Medical Association, Dr Jim C. Hu, of Brigham and Women's Hospital, cited information to show that minimally invasive radical prostatectomy (MIRP), including robot-guided procedures, have increased from 1 percent to 40 percent of all radical prostatectomies from 2001 to 2006.
"Moreover, the widespread direct-to-consumer advertising and marketed benefits of robotic-assisted MIRP in the United States may promote publication bias against studies that detail challenges and suboptimal outcomes early in the MIRP learning curve,” Hu and researchers wrote.
“Until comparative effectiveness of robotic-assisted MIRP can be demonstrated, open RRP, with a 20-year lead time for dissemination of surgical technique relative to MIRP, remains the gold standard surgical therapy for localized prostate cancer."
Dr Hu’s team compared the outcomes of men with prostate cancer who underwent MIRP vs RRP.
Based on U.S. Surveillance, Epidemiology, and End Results Medicare data, researchers found that 1,938 had underwent MIRP, while 6,899 had chosen RRP.
They also found that the use of MIRP increased almost 5-fold, from 9.2 percent in 2003 to 43.2 percent in 2006-2007.
What’s more, the team noted that men who underwent MIRP had shorter hospital stays, were less likely to need transfusions and were at lower risk of postoperative respiratory complications.
"However, men undergoing MIRP vs. RRP experienced more genitourinary complications [involving the genital and urinary organs or their functions; 4.7 percent vs. 2.1 percent) and were more often diagnosed as having incontinence and erectile dysfunction. The need for additional cancer therapies was similar by surgical approach," researchers wrote.
"In light of the mixed outcomes associated with MIRP, our finding that men of higher socioeconomic status opted for a high-technology alternative despite insufficient data demonstrating superiority over an established gold standard may be a reflection of a society and health care system enamored with new technology that increased direct and indirect health care costs but had yet to uniformly realize marketed or potential benefits during early adoption."
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Source: RedOrbit Staff & Wire Reports
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