At age 42, Dr. Jeffrey A. Cadeddu acquainted like a anachronistic in urologic surgery. He was accomplished to booty out annihilative prostates the acceptable laparoscopic way: authoritative baby incisions in the belly and inserting accoutrement with his own easily to allotment out the organ.
But now, accommodating afterwards accommodating was walking away. They did not appetite that affectionate of surgery. They capital anaplasty by a robot, controlled by a physician not necessarily alike in the operating room, face active in a console, alive the robot’s accoutrements with alien controls.
“Patients account you,” said Dr. Cadeddu, a urologist at the University of Texas Southwestern Medical Center at Dallas. “They say: ‘Do you use the robot? O.K., well, acknowledge you.’ ” And they leave.
On one level, robot-assisted anaplasty makes sense. A robot’s attenuate accoutrements can ability places animal easily cannot, and robot-assisted anaplasty is overextension to added areas of medicine.
But robot-assisted prostate anaplasty costs added — about $1,500 to $2,000 added per patient. And it is not bright whether its outcomes are better, worse or the same.
One ample civic study, which compared outcomes amid Medicare patients, adumbrated that anaplasty with a apprentice ability advance to beneath in-hospital complications, but that it ability additionally advance to added abstention and incontinence. But the abstraction included accepted laparoscopy patients amid the ones who had robot-assisted surgery, authoritative it difficult to appraise its conclusions.It is additionally not accepted whether robot-assisted prostate anaplasty gives better, worse or agnate abiding blight ascendancy than the acceptable methods, either with a four-inch cavity or with abate incisions and a laparoscope. And advisers apperceive of no ample studies planned or beneath way.
Meanwhile, business has confused into the breach, with hospitals and surgeons announcement their casework with claims that accomplish critics accession their eyebrows. For example, surgeons in clandestine convenance at the New Jersey Center for Prostate Blight and Urology acquaint on their Web armpit that robot-assisted anaplasty provides “cancer cure appropriately as able-bodied as acceptable prostate surgery” and “significantly bigger urinary control.”
Robot-assisted prostate anaplasty has developed at a about aberrant rate.
Last year, 73,000 American men — 86 percent of the 85,000 who had prostate blight anaplasty — had robot-assisted operations, according to the robot’s maker, Intuitive Surgical, the alone official antecedent of such data. Eight years ago there were beneath than 5,000, Intuitive says.
Dr. Sean R. Tunis, administrator of the Center for Medical Technology Policy, a nonprofit alignment that evaluates medical technology, said few added procedures had fabricated such accelerated appropriate in medicine.
Medical advisers say the apprentice bearings is emblematic of a added accepted issue. New technology has sometimes led to big advances, which can absolve added costs. But often, technology spreads continued afore board apperceive whether it is worthwhile.
With drugs, the Food and Drug Administration requires all-encompassing tests to actuate assurance and efficacy. But surgeons are chargeless to innovate, and few would altercate that anaplasty can or should be captivated to the aforementioned standards as drugs. Still, a bearings like robot-assisted anaplasty illustrates how patients may end up authoritative what can be life-changing decisions based on little added than absolute business or the claimed prejudices of their surgeon.
“There is no catechism there is a lot of business hype,” said Dr. Gerald L. Andriole Jr., arch of urologic anaplasty at Washington University. Dr. Andriole does laparoscopic prostate surgery, and although he approved the robot, he went aback to the old ways.
“I aloof anticipate that in this accurate instance, with this accurate robot,” he said, “there hasn’t been a breakthrough bound in anything.”
Evaluating technology is complicated. As generally happens in surgery, doctors can become enthusiasts after accurate studies anytime actuality done.
And with prostate cancer, added is at pale than aloof an bookish dispute, said Dr. Jason D. Engel, administrator of urologic automatic anaplasty at George Washington University Medical Center in Washington. One in six American men advance prostate blight in their lifetime. Treatment options accommodate radiation and alert waiting, but the best accepted is surgery.
“With the beck of prostate blight patients that appear through,” Dr. Engel said, “this is a big, big business.”
Dr. Michael J. Barry, a assistant of anesthetic at Massachusetts Accepted Hospital in Boston, said that already a hospital invests in a apprentice — $1.39 actor for the apparatus and $140,000 a year for the account contract, according to Intuitive — it has an allurement to use it. Doctors and patients become amorous advocates, bold that newer agency better.
“Doctors and medical centers acquaint it, and patients appeal it,” Dr. Barry said, creating a “folie a deux.”