The HAS has issued a favorable opinion for reimbursement of prostate ablation by robot-assisted surgery, in the treatment of prostate cancer.
In the field of the prostate, surgical robots are taking an increasing place. The High Authority for Health (HAS) has just issued a favorable opinion for reimbursement by Social Security of “total prostatectomy by robot-assisted laparoscopy” for the treatment of localized prostate cancer.
“In France, the annual number of total prostatectomies is estimated at nearly 20,000,” specifies the HAS. Reference treatment in certain cases of prostate cancer, these total ablations are performed either by open surgery or by laparoscopy, conventional or robot-assisted ”.
No better than other techniques
The HAS has therefore evaluated robot-assisted surgery and considers that “when it is carried out within a defined organizational framework, it can represent one of the possible modalities of total prostatectomy during the treatment of localized but worthless prostate cancer. added value demonstrated compared to other techniques ”.
The improvement in actual benefit (ASMR), a sort of rating given to subsequently assess its level of care, was judged compared to total prostatectomy by open surgery and absent compared to total prostatectomy by conventional laparoscopy.
No more mistakes?
The use of robotics in surgery arouses criticism from some practitioners. In the line of sight: too high a cost and few proven benefits for the patient.
In prostate surgery, this type of intervention would also be more dangerous, according to an American study conducted by researchers at the San Diego School of Medicine (University of California) published in the scientific journal JAMA Surgery.
To reach this conclusion, the team analyzed the patient safety indicators developed by the United States Agency for Health and Quality Research (AHRQ) on American hospitals between 2003 and 2009. In fact, in the United States, this technique is very widespread – much more than in France.
However, according to this work, the risk of medical error for patients has doubled during minimally invasive robotic prostatectomies (MIRPs). A worrying record even more marked in 2006, the year in which American hospitals adopted the pursuit of minimally invasive robotic surgery in the treatment of prostate cancer.
Required training
However, this margin of error would be closely linked to the training of the practitioner. Scientists point to the lack of experience of surgeons using this technique. The team states that “robotic prostatectomy by experienced surgeons has been shown to be of great benefit to patients. With less blood loss, fewer infections, and reduced hospital stays. “
This training is a particularly important step in view of the high speed at which this technology is developing. In 2003, it was estimated that 617 minimally invasive robotic prostatectomies (MIRPs) had been performed in the United States. In 2009, that number increased to 37,753.
.
