Bondsman:

You missed the point.

The point is there is no, and never will be a large scale comparison of RP versus LRP. Therefore, it's silly of you to criticize the medicare data, because this is the best large scale data there will ever be.

Since you sound familiar with studies, you must realize that even a prospective, randomized trial (normally the "gold standard") is WORTHLESS if it has only an hundred or so people in it IF you are interested in picking up a *small difference* in efficacy - say a few percent or so.

Why is this important? It's important because if you have an expensive new piece of hardware you want to sell, you can run several *small* studies and say there's ***no difference*** in survival between it and the procedure you are replacing, knowing full well before you even run the study that will be the case unless there is a very LARGE difference. So the laparoscopic procedure has less side effects and shorter hospital stays. If there was (hypothetically) a 3% WORSE chance of tumor recurrence, but a 10% better side effect profile, wouldn't you rather go with the other procedure that has a better chance of curing you? With cancer, you probably would. And the point is... none of the randomized studies you tout are ever going to show that difference, but a large retrospective study or metaanalysis might.

That is why the medicare study is important.

BTW, I'm not adverse to laparoscopic procedures, the people I know who perform them say the feel they get *better* visualization for some things than with an open procedure. The point is though if for whatever reason they aren't working as well *on a case by case basis*, this needs to be rectified - wouldn't you agree?

oh well yeah, long term effects are, of course, the achilles heel of the short term followup study. a zillion years ago when i had my hernia repair (too much information) they were just bringing in the laparascopic repair which was a pretty quick and trivial affair, but my surgeon basically believed that since I was still young and this would have to last 50 years, he would go with the old "tried and true" until further data came in on the longterm reliability of the laparascopic repair, despite it putting me out of commision for a week. can't argue with that, really.