Robotic Surgery may reduce impotence
The study, published in the Journal of the Amercian Medical Association, has sparked renewed debate over robotically assisted surgery, and over how much surgeons should be obliged to tell patients about their success rates.Evidence suggests that robotic prostate cancer surgery, far from being the saviour of men, is leaving them with more incontinence and impotence than traditional techniques.However, the pioneers of robotic surgery in Australia have defended the procedure, saying the research was flawed.
It found that robotic assistance meant men left hospital a day earlier and they were 10 times less likely to need a blood transfusion.However, more than twice as many (4.7 per cent) suffered ‘’genitourinary'’ complications. Almost a third more (16 per cent) were diagnosed with urinary incontinence, and the rate of erectile dysfunction rose by 40 per cent (to 27 per cent).
Professor Simon Chapman, a public health expert from the University of Sydney, said the study casts strong doubts on the claims made on behalf of the robots by proponents such as the Epworth Hospital’s Tony Costello.The Epworth, in Richmond, pioneered robotic-assisted surgery in Australia in 2003, and now runs two of the country’s five da Vinci robots.
‘’Men are in an enormously vulnerable position. They are not in a position at all to adequately evaluate the claims put to them by a doctor. The issues of urinary incontinence and sexual impotence are really very important for a lot of men, especially now men as young as 40 are being screened [for prostate cancer].'’
The Epworth’s associate professor, David Webb, recently published a paper that found robotic-assisted prostatectomies had completely eliminated ‘’bladder neck'’ problems - previously almost one in 10 prostate surgery patients had experienced a bladder neck contracture.
Neuroscientist Janet Keast, from the University of Sydney, said it was almost impossible to avoid nerve damage during a prostate operation.
‘’I am concerned that people get unrealistic expectations because it is called ‘nerve sparing’ surgery,'’ she said. The skill of the surgeon, rather than use or otherwise of a robot, was a better guide to how likely major nerve damage would be.
