The results of a new study casting doubts on the less-invasive keyhole surgery for prostate cancer, suggest there is a higher risk of lasting incontinence and impotence, in comparison with traditional surgery, adding to the confusion around prostate cancer treatments that can sometimes lead to urinary and sexual problems.

Increasingly, men are opting for laparoscopic or keyhole surgery to have a cancerous prostate removed, which often involves the highly marketed da Vinci robotics system, whose popularity has been rising, without a rigorous head-to-head comparison of it with standard surgery.

Researchers, whose study appears in the Journal of the American Medical Association, analyzed medicare data of nearly 9,000-prostate cancer patients who underwent surgical treatment from
2003-07, with 1,938-patients having had minimally invasive surgery and the other 6,899-patients standard surgery. The data does not mention the number of less invasive cases involving robotics.

Keyhole surgery patients it was found left the hospital within two to three days, on average, including having lower rates of blood transfusions, breathing problems and internal scarring. No difference in the rate of additional cancer therapy down the road was found, which suggests the two techniques are comparable when it comes to cancer control.

However, within 30-days of having surgery, those men who underwent keyhole surgery were more likely to report complications involving genital and urinary function. About 5% of the minimally invasive surgery patients vs. about 2% of the standard surgery patients had these complications, with incontinence and erectile dysfunction increasing after 18 months.

The take home message is that men must do more research before falling for the message from device manufacturers planted stories, radio adverts or billboards. The fact is, in laparoscopic surgery, after making small incisions the doctor uses a tiny camera and instruments for the operation, and when robotics are used, the doctor sitting at a console manipulates similar instruments attached to robotic arms working on the patient.

Between 2001 to 2006, the da Vinci system was the only robot available for such operations, and competing for patients, more hospitals have been on a robotic systems buying spree, advertising faster recovery times, with more doctors taking the 2-day training to learn Intuitive's da Vinci Surgical System.

However, not many of them get to perform enough robot-assisted surgeries to get good at it, which explains the lasting problems the study has thrown up. Previous research has shown doctors who perform the most surgeries and who have gotten really good at using robotic systems achieve the best results.

Not easily mastered, the learning curve for the robotic technique is 150 to 200-patients, with the surgeons simply practicing on the first 150, before they can say they have mastered it.

Even so, Dr. Steve Freedland of Duke University School of Medicine in Durham, N. C., who does prostate surgery says, the results of this study reinforce his decision to stay with traditional, open surgery.

According to the researchers the less-invasive surgery was more popular with affluent, highly educated men, as it may be that they are more likely to seek help for urinary and sexual problems, as compared to men undergoing traditional surgery.

Still, in the early stages of evolution, minimally invasive robotic surgery for prostate cancer, including the surgical techniques for preserving urological function and preventing incontinence and impotence still need to be perfected.