ILoveTTAT2: There is very little good data that shows benefits/drawbacks, and the data is flawed... the entire rest of the article says so!
Exactly. I say "good for Ontario" for demanding solid evidence instead of just jumping on the technology bandwagon
But in the rush to adopt the da Vinci technology, few researchers conducted randomized controlled trials comparing robot-assisted prostatectomy to open surgery, the gold standard in evidence.
"One of the stories here," Dr. Dhalla said, "is why isn't there good evidence?"
He estimated that hundreds of thousands of men around the world have had a robot-assisted prostatectomy, "and there's been one, tiny randomized control trial in Australia with about 300 patients comparing the open approach with the robotic approach."
That Australian study, published a year ago in The Lancet, was the foundation of OHTAC's thumbs-down for robot-assisted prostatectomies.
The study, which followed 157 men who underwent robot-assisted surgery and 151 who underwent open surgery, found no statistically significant difference in cancer control, urinary function or sexual function between the two types of surgery.
Critics of the OHTAC report say the Australian study has profound shortcomings – namely, that it compared the work of an experienced open surgeon to that of a robotics novice.
The study also reported outcomes only three months after surgery, which could mask longer-term benefits of the robotic approach, said Stephen Pautler, a professor of surgery at Western University in London, Ont., who was among the urologists who asked to have their names taken off OHTAC's final report.
"We said you [OHTAC] are basing the entire economic analysis on a flawed study," Dr. Pautler said. "They were absolutely rigid and would not change their mind."
(Intuitive, for its part, said in an e-mailed statement there are many studies backing the da Vinci Surgical System that rely on "real-world evidence." The company called OHTAC's heavy reliance on randomized controlled trial data "inconsistent" with recent health-technology assessments in other places, including Alberta, the only province that funds robot-assisted surgery.)But Anthony Adili, the chief of surgery at St. Joseph's Healthcare and a cheerleader for robotic surgery, said he couldn't fault OHTAC when the committee had so little high-quality evidence at its disposal.