Hospitals eye prostate surgery robot that some call 'a toy'

Canadian hospitals are planning to spend millions of dollarson robotic equipment to remove prostates less invasively, but the benefits of the expensive technology have yet to be proven.

Every year in Canada, almost 20,000 men are diagnosed with prostate cancer, and about 8,000 are advised to have the prostate removed.

At St. Joseph's Health Centre in London, Ont., surgical oncologist Dr. Stephen Pautler uses high-tech joysticks to control the da Vinci robot'shands, whichmake smaller incisions compared with traditionalprostate surgery.It resembles a smaller version of robots used on assembly lines.

"We are able to see with a 10 to 12 times magnification using the robot," Pautler said. "So it allows us to be more precise than we are in open surgery. We can't stick our head in an incision so it makes it much easier."

The smaller, more precise incisions reduce bleeding and shorten recovery times. The robotmay also help to avoid cutting nerves and muscle that control thebladder and erections. Incontinence and impotence are common side-effects of prostate surgery.

Fewer side-effects claimsunfounded?

But skeptics wonder if the robots are worth their $3 millionto $4 million price tag and the higher cost per surgical patient, given that numerous studies haven't found evidence to back to claim of fewer impotence and bladder-control side-effects.

"The robot is a phenomenal toy and surgeons love to use it," said Dr. Laurence Klotz, a urologist at Sunnybrook Hospital in Toronto. "So far, the data has not shown any really substantial difference in terms of patient outcome."

The high cost and lack of evidence hasn't stopped two hospitals in London, Ont.,and one in Montreal from buying the surgical robots, and more want them. In the U.S., hospitals have purchased 300robots.

In Edmonton, surgeons perform the same laparoscopic technique, making a series of small holes in the abdomen, but using their own hands instead of a robot's.The manual technique is cheaper and offers the same advantages of less bleeding and shorter recovery as the robotic version.

The robots offer a benefit that is sometimes overlooked: It's difficult for surgeons to learn how to do the less invasive laparoscopic procedure with their own hands, said Dr. Michael Hogart, head of urology at the Edmonton hospital, which is fundraising for the technology.

Buying a robot will result in about 150 more patients a year receiving the less invasive form of surgery, he said.

The futuristic device could one day be used for other forms of surgery such as heart bypasses, hysterectomies and some types of plastic surgery, making it a better investment.

For patient Peter Shaw, it was an easy choice to go under the miniature knives of the da Vinci robot last year.

"The only disadvantage from my point of view is that, of course, I was totally out during the surgery, and being a former science teacher, I was interested in the technology.I wanted to see it."