Despite limited data on outcome, the use of minimally invasive radical prostatectomy (MIRP) has surged as a result of aggressive marketing of the potential benefits over conventional open surgery even at greater costs.
A study published in JAMA reported mixed results. It was a population-based observational cohort study that identified nearly 2000 men who had MIRP and nearly 7000 had traditional surgery.
The researchers found that use of MIRP increased from 9% in 2003 to 43% in 2006-7. White and Asian living in high income areas are more likely to opt for MIRP. They also found that MIRP was associated with shorter hospital stay and fewer blood transfusion or other postoperative complications. However MIRP was associated with incontinence and erectile dysfunction in the long term.
The authors concluded that their findings reflected "a society and health care system enamored with new technology that increased direct and indirect health care costs but had yet to uniformly realize marketed or potential benefits during early adoption."
Source: "Comparative Effectiveness of Minimally Invasive vs Open Radical Prostatectomy". JAMA 2009;302(14):1557-1564. (f/t via Athens)
Showing posts with label open surgery. Show all posts
Showing posts with label open surgery. Show all posts
Tuesday, October 27, 2009
Thursday, January 31, 2008
Endoscopy better than open surgery for Abdominal Aortic Aneurysms
the January 31 issue of the New England J of Medicine reported a large observational study on endovascular vs. open repair of Abdominal Aortic Aneurysms (AAA).
Endovascular repair is a minimally invasive technique involving placing a stent via a catheter while open repair involves placing a graft through a large incision. However there have been concerns about the long term benefits of endovascular repair.
The study, including more than 45,000 patients on the US Medicare, found those who had endoscopic repairs had a higher survival rate 30 days after the procedure, the benefit is greater the older the patient. By 4 years, rupture and minor reintervention were more likely in the endovascular repair group than the open repair group. The author said these were balanced by an increase in laparotomy-related reinterventions and hospital admission after open surgery, however, not everyone is suitable for endoscopic stenting.
Source: "Endovascular vs. Open Repair of Abdominal Aortic Aneurysms in the Medicare Population" , NEJM Volume 358(5):464-474 ( subscription required)
Endovascular repair is a minimally invasive technique involving placing a stent via a catheter while open repair involves placing a graft through a large incision. However there have been concerns about the long term benefits of endovascular repair.
The study, including more than 45,000 patients on the US Medicare, found those who had endoscopic repairs had a higher survival rate 30 days after the procedure, the benefit is greater the older the patient. By 4 years, rupture and minor reintervention were more likely in the endovascular repair group than the open repair group. The author said these were balanced by an increase in laparotomy-related reinterventions and hospital admission after open surgery, however, not everyone is suitable for endoscopic stenting.
Source: "Endovascular vs. Open Repair of Abdominal Aortic Aneurysms in the Medicare Population" , NEJM Volume 358(5):464-474 ( subscription required)
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