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Dr. Steve Freedland of Duke University School of Medicine in Durham, N.C., said he doubts the findings will dampen the enthusiasm for robotic surgery -- he termed it "mass hysteria over new technology" -- because surgeons will claim better-than-average results when they talk to men considering their options.
Freedland, who does prostate surgery, said the results just reinforce his decision to stick with traditional, open surgery.
"One of the reasons why health care in this country is extremely expensive is because it's assumed that what's newest must be best," Freedland said.
The researchers found that the less-invasive surgery was more popular among more affluent, highly educated men. So it might be that those patients are more likely to seek help for urinary and sexual problems compared to men who had traditional surgery, said Dr. Ashutosh Tewari, director of the Prostate Cancer Institute at NewYork-Presbyterian Hospital/Weill Cornell Medical Center.
Tewari, who receives research funding from Intuitive Surgical and had no role in the study, faulted the research for lumping all minimally invasive surgeries together, both robotic and those using older laparoscopic techniques.
Ryan Rhodes, a spokesman for Intuitive Surgical, said there have been more than 800 previous studies on robot-assisted prostate surgery. "The overwhelming majority of these show superior results," both for cancer treatment and urinary continence and sexual function, Rhodes said in an e-mail.
Dr. Greg Zagaja of University of Chicago Medical Center, who does similar research but wasn't involved in the new study, said the Medicare billing codes don't necessarily represent the surgical outcomes. He noted there wasn't a difference in the rate of procedures for treating incontinence and sexual dysfunction between the two groups.
Zagaja said the best advice for men is to ask how many robot-assisted surgeries a doctor has done.
One patient, Jack Denney, 65, of Lancaster, Ohio, said he didn't ask how many surgeries the doctor had done, and he still doesn't know.
"I knew I wasn't the first," Denney said. The retired tool and dye maker is cancer-free, but has had lasting erectile problems since his robot-assisted surgery in May 2007.
His advice? "Expect erectile dysfunction, no matter what they tell you," Denney said. "I think they overrate their success."
The study was funded by a Department of Defense grant to the lead author.
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