“This paper,” Dr. Hu said, “demonstrates that there are hidden risks for patients who opt for laparoscopic or robotic surgery.”
In laparoscopy, a surgeon inserts instruments through small cuts in the skin instead of making large incisions to expose the organs. The laparoscope is a slender tube that allows the surgeon to see inside the body. Most minimally invasive prostate operations are robot assisted.
, published on May 10 in The Journal of Clinical Oncology, examined a sample of 2,702 Medicare
patients undergoing radical prostatectomy
, the complete removal of the prostate, from 2003 to 2005. Minimally invasive procedures increased to 31 percent of all radical prostatectomies in 2005 from 12.2 percent in 2003.
Laparoscopic surgeries — the study does not specify how many were robot assisted — resulted in a 27 percent lower risk of complications during and immediately after the operation. Those patients had less bleeding, fewer breathing problems, fewer cardiac problems and fewer immediate complications over all. The patients needed an average of 1.42 days in the hospital, compared with more than four days for those who had open surgery.
But the men who had the laparoscopies had a 40 percent greater risk of scarring that interferes with organ function, a complication that requires additional surgery. And within six months of their operations, more than one-quarter needed additional hormonal or drug therapy compared with one in 10 of those who had conventional surgery.
Dr. Mark L. Gonzalgo, an assistant professor of urology at Johns Hopkins who was not involved in the study, said the laparoscopic procedure had disadvantages. “You can’t feel the cancer
in robotic operations,” he said. “And the ability to feel the cancer with your hands may provide some additional advantage.”
Even in robotic procedures, he added, “the operation is performed by the surgeon, not the robot. You have to have a surgeon who understands the anatomy.”
At Johns Hopkins, Dr. Gonzalgo said, the open procedure continues to be used in most radical prostatectomies.
Other experts found the study noteworthy. “It’s a very important paper, the first that has come out in the field that has used a national database to examine outcomes,” said Dr. Peter T. Scardino, chairman of the surgery department at the Memorial Sloane-Kettering Cancer Center.
The study has some problems, he said, noting that data on the seriousness of the cancer in each case was not available, leaving no way to know whether less serious tumors
were consistently selected for laparoscopic surgery. Still, he said, the results “fit with everything we know.”"