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Rapid increase in number of radical prostatectomies in the USA

Posted Aug 20 2010 12:00am

Another article in this week’s New England Journal of Medicine addresses the rapid increase in the number of robot-assisted surgical procedures carried out in the US between 2005 and 2008.

Barbash and Glied have studied the impact of the introduction of the da Vinci robot on the numbers of surgical procedures carried out in the US each year and the associated costs of those surgeries. The complete text of their article is again available on line.

They focus in particular in the significant increase in the annual number of radical prostatectomies that appear to have occurred because of the introduction of the da Vinci technology, and the increased costs of these surgeries.

The “New” Prostate Cancer InfoLink recognizes that there are many complex issues related to adoption of such technology. Surgical cost is just one of these. Barbash and Glied do not, however, address what may have been a significant saving from less post-surgical hospital days associated with laparoscopic as opposed to open prostate cancer surgery and a reduction in the overall need for blood transfusions.

We have no doubt that someone will, in the end, carry out a detailed analysis of the cost-benefit equation associated with robot-assisted prostatectomy. However, it is almost certainly too late to put the genie back in the bottle. For better or worse, surgeons training today have learned to carry out radical prostatectomy using the da Vinci robot. Most of them would have to be completely retrained if they needed to learn to carry out open surgeries. That is most unlikely to happen!

There is, of course, a whole different question around how many of the radical prostatectomies carried out over the past 5 years or so were actually medically justifiable in men with low-risk prostate cancer most particularly in those men with a life expectancy of less than 10 years.

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