A major study of patient satisfaction and regret following open prostatectomy and robot-assisted laparoscopic prostatectomy provides some important lessons for surgeons.*
The research, recently published in the European Journal of Urology, shows 19 per cent of patients regretted their treatment choice and patients who had robot-assisted surgery were most likely to be dissatisfied.
The authors suggest the regret is “possibly because of higher expectation of an ‘innovative procedure'”.
Their conclusion is one for all urological surgeons to note. “We suggest that urologists carefully portray the risks and benefits of new technologies during preoperative counselling to minimise regret and maximise satisfaction.”
In recent years, the treatment of prostate cancer has been a rapidly developing field, providing patients with a wide range of different choices.
Brachytherapy and HIFU offer non-surgical options and for those who want surgery, there are open, laparoscopic and nerve-sparring options, depending upon your diagnosis and treatment provider.
At the same time, patients are becoming increasingly proactive, using the internet to research and consider the different options themselves, as well as the traditional consultation with the urologist.
Increased choice is without doubt a positive benefit for patients, but as urology centres – both private and NHS – seek to attract patients, we have a responsibility to carefully counsel them about the advantages and disadvantages of treatments.
There is a distinctive risk when a procedure is perceived to be new and especially “innovative”. The media will always be interested in the next “pioneering operation”, particularly one which involves robots.
A newspaper article will tend to portray the new procedure as an immaculate solution, which corrects all the risk and disadvantages of other procedures.
As surgeons, we have a responsibility to provide patients with a more sober and informative picture, acknowledging limitations as well as benefits.
The patient satisfaction study was based on the responses of 400 men who had undergone retropubic radical prostatectomy (RRP) or robot-assisted laparoscopic radical prostatectomy between 2000 and 2007 in the US.
The report’s authors also examined patients urinary domain scores, hormonal domain scores and found scores were independently linked with regret.
It is still early days for robotic surgery in the UK. In prostate cancer surgery, there are currently six Da Vinci robotic machines in the UK, compared with 350 in America.
There is no current evidence that robotic surgery provides better outcomes for patients, in terms of urinary symptoms, post operative sexual function or post-operative risks and complications.
It seems certain that robotic surgery will increase within the UK during the next decade, with NHS and private centres purchasing the Da Vinci machines.
This will provide even more choice for patients, which is in principle, a positive development.
It is however vital that patients are given accurate and comprehensive information to enable them to make an informed choice, rather than simply being over-sold a new product.