Comparative Effectiveness of Minimally Invasive vs Open Radical Prostatectomy
Following the description of consistently reproducible advantages of minimally invasive radical prostatectomy (MIRP) with and without robotic assistance in 2000-2001,1 – 2 use of MIRP has surged.3 – 4In particular, use of robotic-assisted MIRP increased from 1% to 40% of all radical prostatectomies from 2001 to 2006.5 – 6 Many patients intuitively perceive minimally invasive approaches to reduce complications compared with conventional open operations and prefer minimally invasive procedures because of smaller incisions requiring less analgesics and shorter hospital stays, even at greater cost.7
Moreover, the widespread direct-to-consumer advertising and marketed benefits of robotic-assisted MIRP in the United States may promote publication bias against studies that detail challenges and suboptimal outcomes early in the MIRP learning curve.8 Until comparative effectiveness of robotic-assisted MIRP can be demonstrated, open retropubic radical prostatectomy (RRP), with a 20-year lead time for dissemination of surgical technique9 relative to MIRP, remains the gold standard surgical therapy for localized prostate cancer.10
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