Sunday, March 24, 2013

Beating a dead robot. Thanks to @ashishkjha.

I don't want to overdo my commentary about the inflated claims of robotic surgery companies, but I have to cite a recent tweet by Ashish Jha about this recent article in the Annals of Surgery, "Impact of Robotic Surgery on Sexual and Urinary Functions After Fully Robotic Nerve-Sparing Total Mesorectal Excision for Rectal Cancer."  He said:

Underpowered study, no controls claims robotic surgery good 4 rectal cancer. Why publish this stuff?

No doubt he was referring to the methodology:

Methods and Procedures: From April 2008 to December 2010, 74 patients undergoing fully robotic resection for rectal cancer were prospectively included in the study. Urinary and sexual dysfunctions affecting quality of life were assessed with specific self-administered questionnaires in all patients undergoing robotic total mesorectal excision (RTME). Results were calculated with validated scoring systems and statistically analyzed.

And the self-reported results:

Results: The analyses of the questionnaires completed by the 74 patients who underwent RTME showed that sexual function and general sexual satisfaction decreased significantly 1 month after intervention. Subsequently, both parameters increased progressively, and 1 year after surgery, the values were comparable to those measured before surgery. Concerning urinary function, the grade of incontinence measured 1 year after the intervention was unchanged for both sexes. 

And then the meaningless conclusion:

RTME allows for preservation of urinary and sexual functions. This is probably due to the superior movements of the wristed instruments that facilitate fine dissection, coupled with a stable and magnified view that helps in recognizing the inferior hypogastric plexus.

I thought these journals required peer review. I guess not.

Let's compare it with an earlier study, "A comparison of open and robotic total mesorectal excision for rectal adenocarcinoma." This one doesn't jump to conclusions about the "superiority" of one method versus another and reminds us of the importance of large randomized trials.  Highlights:

This retrospective study was designed to compare open with robot-assisted total mesorectal excision for rectal adenocarcinoma. Total procedure time was longer in the robotic group (P = .003), but blood loss was less (P = .036). Lymph node yield, intraoperative and postoperative complications, and length of stay were all comparable.  There were 3 positive circumferential margins in the open group vs none in the robotic group, but this did not reach statistical significance.


Robotic total mesorectal excision is feasible and safe, and is comparable to open total mesorectal excision in terms of perioperative and pathological outcomes. The longer operative time associated with robotic total mesorectal excision could decrease as experience with this relatively new technique increases. Large randomized trials are necessary to validate the potential benefits of less blood loss and lower margin positivity rates observed in this study.

No comments: