Canada starts fight-back against bloodless surgery?
I'm sure OrphanCrow will be able to fill in the details for us.
Front page news with picture all over the Canadian Globe and Mail newspaper today.
With major double-page spread across the whole of pages 8 and 9 in the newspaper's front section.
Globe and Mail, Tuesday 8 August 2017.
The patient, a 70-year-old man with high-risk prostate cancer, was a Jehovah’s Witness.
His religion was one of the reasons he decided to undergo surgery at St. Joseph’s Healthcare in Hamilton, home to a robot named da Vinci whose steady metal hands can remove a prostate with scant risk of the blood transfusions forbidden by the man’s faith.
On a recent afternoon, the patient laid unconscious on an operating table as surgeon Bobby Shayegan and his team plunged a camera and three robotically controlled surgical instruments through small incisions in his abdomen.
Dr. Shayegan settled himself in front of a three-dimensional screen, clasped the two joysticks that controlled the tools inside his patient’s pelvis and proceeded to cut, cauterize and stitch until he freed the man’s prostate, pulling it out through one of the original incisions.
There was next to no blood.
“That was routine,” Dr. Shayegan said afterward, holding the plum-sized gland that he and the robot had removed together. “Very routine.”...
In its first real ruling on a robotic surgery, the expert committee that advises Ontario on which new health technologies to pay for said there was no good evidence that robot-assisted radical prostatectomy is any better than conventional open surgery when it comes to controlling cancer or preserving urinary and sexual function.
The panel said the robot’s other benefits – patients have smaller incisions, lose less blood, suffer less pain and leave the hospital sooner – were not significant enough to justify spending, on average, an extra $3,224 a case, a figure that does not include the millions that wealthy benefactors have spent buying the machines for Canadian hospitals.https://www.theglobeandmail.com/life/health-and-fitness/health/the-fight-for-robots-in-canadas-operatingrooms/article35897282/
It's unfair to the payers of a public health system to burden them with the special and expensive care demanded by a small group of people who holds beliefs that originate in 3,000 year old rites. One more example of "how religion poisons everything"
My dad had this type of surgery. If he would have not been a witness, and he couldn't care less about BT's, he would have still asked for this surgery. If they had asked him to pay up the extra money, he would have paid the extra money.
It's 99% about Ontario being cheap asses and 1% about BT's and Jehovah's Witnesses. The improvements on risk of incontinence and sexual dysfunction alone are worth it!
There is very little good data that shows benefits/drawbacks, and the data is flawed... the entire rest of the article says so!
ILoveTTAT2: There is very little good data that shows benefits/drawbacks, and the data is flawed... the entire rest of the article says so!
Exactly. I say "good for Ontario" for demanding solid evidence instead of just jumping on the technology bandwagon
But in the rush to adopt the da Vinci technology, few researchers conducted randomized controlled trials comparing robot-assisted prostatectomy to open surgery, the gold standard in evidence.
"One of the stories here," Dr. Dhalla said, "is why isn't there good evidence?"
He estimated that hundreds of thousands of men around the world have had a robot-assisted prostatectomy, "and there's been one, tiny randomized control trial in Australia with about 300 patients comparing the open approach with the robotic approach."
That Australian study, published a year ago in The Lancet, was the foundation of OHTAC's thumbs-down for robot-assisted prostatectomies.
The study, which followed 157 men who underwent robot-assisted surgery and 151 who underwent open surgery, found no statistically significant difference in cancer control, urinary function or sexual function between the two types of surgery.
Critics of the OHTAC report say the Australian study has profound shortcomings – namely, that it compared the work of an experienced open surgeon to that of a robotics novice.
The study also reported outcomes only three months after surgery, which could mask longer-term benefits of the robotic approach, said Stephen Pautler, a professor of surgery at Western University in London, Ont., who was among the urologists who asked to have their names taken off OHTAC's final report.
"We said you [OHTAC] are basing the entire economic analysis on a flawed study," Dr. Pautler said. "They were absolutely rigid and would not change their mind."
(Intuitive, for its part, said in an e-mailed statement there are many studies backing the da Vinci Surgical System that rely on "real-world evidence." The company called OHTAC's heavy reliance on randomized controlled trial data "inconsistent" with recent health-technology assessments in other places, including Alberta, the only province that funds robot-assisted surgery.)
But Anthony Adili, the chief of surgery at St. Joseph's Healthcare and a cheerleader for robotic surgery, said he couldn't fault OHTAC when the committee had so little high-quality evidence at its disposal.
And then there was this, an article that was dated 2008:
Regrets After Prostate Surgery
BY TARA PARKER-POPEAugust 27, 2008 9:26 am
One in five men who undergoes prostate surgery to treat cancer later regrets the decision, a new study shows. And surprisingly, regret is highest among men who opt for robotic prostatectomy, a minimally invasive surgery that is growing in popularity as a treatment.
The research, published in the medical journal European Urology, is the latest to suggest that technological advances in prostate surgery haven’t necessarily translated to better results for the men on which it is performed. It also adds to growing concerns that men are being misled about the real risks and benefits of robotic surgical procedures used to treat prostate cancer.
Of the 219,000 men in the United States who learn they have prostate cancer each year, nearly half undergo surgical removal of the gland, according to the National Cancer Institute.
Duke University researchers surveyed 400 men with early prostate cancer who had undergone either a traditional “open” surgical procedure or newer robotic surgery to remove the prostate. Overall, the vast majority of men were satisfied. However, 19 percent regretted their treatment choice. Notably, men who had undergone robotic surgery were four times more likely to regret their choice than men who had undergone the open procedure.
Researchers say the higher level of regret among robotic patients suggests that they had higher expectations for their recovery, possibly because the robotic procedure is widely touted as a more innovative surgery than traditional prostatectomy. Even among men who had the same scores on erectile function and other measures of post-surgery recovery, the robotic patients still reported a higher level of dissatisfaction and regret than other men.
Part of the problem may be that doctors who perform robotic prostatectomies commonly cite potency rates as high as 95 percent and above among their patients, giving patients an unrealistic view of life after surgery.
But the data are highly misleading. Researchers often define potency as simply being able to achieve an erection that is “adequate” for intercourse — but for many men, that definition doesn’t capture their ongoing struggle to return to a normal sex life. Earlier this year, researchers from George Washington University and New York University used a more realistic definition of potency, showing that after surgery, fewer than half of the men studied felt their sex lives had returned to normal within a year.
Another important finding of the new research showed that men were less likely to regret their choice shortly after surgery. The men who were long past surgery experienced more regret. That finding likely speaks to the fact that as time passes after surgery, men gain a more realistic view of lingering health and quality-of-life issues like erection problems and other changes in their sex lives.
The Duke researchers said that the study shows urologists need to communicate more carefully the risks and benefits of the treatment prior to surgery so that men have more realistic expectations of what to expect.
It seems the evidence is out there but for whatever reason this study focused on only a small sample from 1 country.
However it does seem apparent that robotic surgery does result in less bleeding, less pain and a quicker recovery time than conventional surgery so that in and of itself does give a thumbs up for the robotic route. So if we factor in less ward time, less pain killers and less use of donated blood I am sure the overall saving would outweigh the greater cost of the procedure. I am guessing that the way the health system works is that the costs of the procedure is given over directly to the hospital whereas the cost of medicine, ward care and blood comes from different departments and costs the hospital, directly, less. The way costs are structured often has an impact on what gets offered more so than the real world cost.
It seems the reason for dissatisfaction with the robotic route has more to do with initially overselling the procedure rather than complications with the actual procedure itself.
... if we factor in less ward time, less pain killers and less use of donated blood I am sure the overall saving would outweigh the greater cost of the procedure. I am guessing...
Yes, it is a guess. And there isn't evidence to back up that guess. Unfortunately, when it comes to medicine and science, what seems to be intuitively right and logical, often isn't. That is why we use the scientific method. And scrutinize the method and results at all times
"Yes, it is a guess." - OC
Of course. I don't have access to the accounts of that Australian hospital!
"And there isn't evidence to back up that guess" - OC
Well there could be depending on how the accounts are handled at that hospital. I do know that over here in the UK costs can be moved around to make it very difficult to get an accurate representation of costs...