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Minimally invasive radical prostatectomy shows advantages, but also certain complications
Date:10/13/2009

New research indicates that the use of minimally invasive procedures (including the use of robotic assistance) for radical prostatectomy, which have increased significantly in recent years, may shorten hospital stays and decrease respiratory and surgical complications, but may also result in an increased rate of certain complications, including incontinence and erectile dysfunction, according to a study in the October 14 issue of JAMA, a theme issue on surgical care.

Jim C. Hu, M.D., M.P.H., of Brigham and Women's Hospital, Boston, presented the findings of the study at a JAMA media briefing in Chicago.

Minimally invasive radical prostatectomy (MIRP), in particular with the use of robotic assistance, has increased from 1 percent to 40 percent of all radical prostatectomies from 2001 to 2006, according to background information in the article. But this rapid increase has occurred despite limited data on outcomes and greater costs compared with open retropubic radical prostatectomy (RRP; surgery in which an incision is made in the lower abdomen to remove the prostate, which is located in the pelvis behind the pubic bone).

"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. 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," the authors write.

Dr. Hu and colleagues assessed the outcomes for men with prostate cancer who underwent MIRP (n = 1,938) vs. RRP (n = 6,899), using U.S. Surveillance, Epidemiology, and End Results Medicare linked data. During the study period, the use of MIRP increased almost 5-fold, from 9.2 percent in 200
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Contact: Lori Shanks
ljshanks@partners.org
617-534-1604
JAMA and Archives Journals
Source:Eurekalert

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