JAMA article

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urologyurologyu...
JAMA article

Has anyone read the JAMA article from last week 2009 Oct 14;302(14):1557-64 Comparative effectiveness of minimally invasive vs open radical prostatectomy.Looks like open surgery might be better for prostate cancer.Has anyone heard what the Robotic guys think of this?http://www.ncbi.nlm.nih.gov/pubmed/19826025?ordinalpos=2&itool=EntrezSys...Dr. Menon seems a little shaken: http://www.henryfordhealth.org/body.cfm?id=52750is this being talked about at interviews

Edited by: nicky on 05/11/2015 - 19:50 Reason: Updated by FeedsNodeProcessor
Anonymous (not verified)
ISRG going south

Better sell your Intuitive stock...
In today's healthcare environment, higher costs and lack of superiority = rebirth of the scalpel.

prids
probably not

doubt it, the robot is a superior tool, not to invest with time and money in a technology so powerful with such a great future would be foolish. Imagine the alternative, in 10 years robotic surgery not existing, but we will probably have flying cars. Those two scenarios dont fit. We will have flying cars and robotic surgery.

phoenixsurge
Seriously?

Frankly, I doubt we'll ever have flying cars, and I honestly think that the cost needs to come down dramatically for the robot or we won't have that either. The JAMA article has the essential flaw in that it did not differentiate between robotic versus a laparoscopic approach. Dr. Chodak had an interesting video article on the lack of comparative benefit and the associated added risk/cost associated with the robotic cases on Medscape. I think the next real fight is not going to be open vs minimally invasive, but robotic assisted vs (simple) laparoscopic.

(The link to Dr. Chodak's piece didn't go through, but it is titled: "Radical Prostatectomy: Should Government Reimburse Based on 'Least Costly Alternative'?")

Anonymous (not verified)
"doubt it, the robot is a

"doubt it, the robot is a superior tool, not to invest with time and money in a technology so powerful with such a great future would be foolish."

You say that because we have proven it or because you think its better. Urologists as a field have soul their sole to this technology. Someone down the street got a robot and started marketing it and so everyone else had to get on board. This article exists because we didn't effectively look at this technology in prospective manner. Until we clean up our own house people are going to respond with articles such as this.

Anonymous (not verified)
A couple of problems with this paper

1. it is retrospective
2. it doesn't actually look at complications, it looks at icd-9 codes, which means that the data is inherently dirty. if you've ever worked with these datasets, you'll know what i mean. in order for analysis to be accurate, you have to assume that everyone codes the same way and in a cosistent manner

that being said, this paper is pretty damning. most internists and pcp's who read this will not do so with a critical eye and may simply just believe the conclusions. that's bad news for the guys who've made a career out of robotics.

Anonymous (not verified)
too late 80% of prostates

too late 80% of prostates already being done robotically.

to be honest, i'm actually tired of doing robot prostates. i've actually performed a decent amt of these in residency, but very few open. i guess its a sign of the times, but sometimes i really miss open surgery.

Anonymous (not verified)
JAMA paper

This paper is garbage for multiple reasons. It only got published in JAMA due to the controversy is was guarenteed to create. In addition, the robot advocates (especially on the Intuitive website) have made claims that simply are not true as to the benefits of robotic surgery, and I suspect this article was published in part to counter those claims. It is unwise to draw any conclusions from the paper because:

1. Retrospective
2. Only included patients over 65
3. Took a time period that was relatively early in the robotic learning curve
4. As stated previously, the way that incontinence and impotence were catagorized is flawed and subject to incredible bias. Even though more patients undergoing MIRP had incontinence/impotence, there was no difference in additional procedures performed for incontinence/impotence.