Researchers report higher price tag for robotic prostatectomy surgery

In perfecting the science of medicine, advancements always face exhaustive scrutiny and opposition. Typically, these rigors focus on confirming the efficacy of a procedure or treatment to ensure it remains in the patient's best interest for healing or wellness. More recently, with heightened emphasis on government-funded healthcare, medical procedures such as robotic prostatectomy surgery for prostate cancer treatment are under fire for cost. 

A study recently published in the Journal of Urology undertook a type of cost-benefit analysis of robotic surgery, specifically prostate removal surgery and kidney surgery. Researchers found robot-assisted surgeries to be safer than laparoscopic surgery and traditional, open surgery. At the same time, they reported a higher price tag for the robotic procedures and as leading robotic prostate cancer treatment expert Dr. David Samadi comments, "sadly, this is the component that gets top press."

Robotic prostatectomy surgery is a leading treatment option for men diagnosed with localized prostate cancer. During the procedure, a skilled surgeon guides the fine instruments of the robot through laparoscopic-type incisions to perform the precise and delicate procedure.

Dr. Samadi is Vice Chairman, Department of Urology, and Chief of Robotics and Minimally Invasive Surgery at The Mount Sinai Medical Center in New York and has performed over 3,800 successful robotic prostatectomy procedures. During the study period in 2008, robotic surgery accounted for more than half of all prostate removal surgeries. Today, The National Cancer Institute reports that four out of five radical prostate cancer surgeries in the United States are done with the assistance of the da Vinci Surgical System robot.

"Prostate removal surgery saves the lives of men with prostate cancer," said Dr. Samadi. Prostate removal surgery has been shown to reduce the relative risk of prostate cancer specific mortality. Some prostate cancer experts advocate a watchful waiting approach to prostate cancer believed to be less aggressive or slow growing. Men who choose this path must maintain great vigilance with heightened screening regimens that could last a lifetime.

"More importantly," Dr. Samadi adds, "with robotic surgery quality of life is better preserved. Men who choose robotic prostate removal surgery, in the hands of an experienced surgeon, are able to return to their lives more quickly, cancer free, and with minimal or short-lived side effects." With Dr. Samadi's own SMART Surgery technique ("Samadi Modified Advanced Robotic Technique"), 97 percent of his patients are cancer free after surgery. Augmenting the benefits of Samadi's SMART surgery, 96 percent of the men he operates on regain urinary continence and 85 percent regain sexual function in less than one year after the procedure.

Dr. Samadi believes this surgery comparison study actually paints a very good picture of robotic-assisted surgery. Researchers reported the following benefits of robotic surgery over laparoscopic and traditional surgery.

Robotic Prostate Surgery Wins:

• Hospital stays reduced by at least 1 day
• Less blood loss and lower risk of blood transfusions; less than 2 percent for robotic surgery compared to 5 percent for open surgery
• No deaths reported in the robotic surgery group during study period

Robotic Prostate Surgery Average Cost:

• $700 more than laparoscopic surgery
• $1,100 more than open surgery

In looking at these numbers, Dr. Samadi points out that, in medicine, the cost benefit analysis isn't black and white. He adds, "If we want to talk healthcare dollars and cents, this study only looks at one type of cost associated with prostate cancer treatment, those incurred during the immediate operative period. When you take into account the secondary cost saving attributed to robotic surgery, such as fewer complication, shorter recovery, and subsequent lower societal cost due to work place absenteeism, surely that $700 is more than made up."

Further, Dr. Samadi points out that this study and others like it fail to consider the full life cycle costs of treating prostate cancer through methods other than robotic surgery. "With other prostate cancer treatment options, the damaging side effects on sexual potency and urinary continence can be long-lasting and significant," he says, "The additional, ongoing medical expenses of these conditions must be quantified; however, there is no accounting for the toll these issues take on a man's quality of life."

Finally, Dr. Samadi cautions that despite the great benefits of robotic-assisted surgery for prostate removal and other surgical needs, we must be careful not to let the technology get ahead of us. "We cannot minimize the nature of these procedures. The advancements and capabilities of the robot do not define the procedure's success. A skilled, qualified surgeon is always responsible for the patient's outcome."