Keyhole surgery 'takes longer and costs more'

NICHOLAS TIMMINS

Public Policy Editor

Hi-tech keyhole surgery to remove the gall bladder - an operation widely adopted by surgeons because of its "obvious advantages" - takes longer to do and offers no advantages over more conventional surgery, ahospital study has shown.

The finding yesterday led to calls in the medical journal The Lancet for more such studies into the effectiveness of surgical techniques.

New ones are frequently adopted without trials to prove they are superior to existing operations. Without more studies, the journal argues, surgeons will continue to face the charge that up to half their research is of questionable value.

The study at the Royal Hallamshire Hospital in Sheffield was rare for being a randomised controlled trial - the standard way to assess new drugs. Two hundred patients were allocated at random to a small incision operation or the keyhole technique, and the assessment of the outcome was hidden by providing dressings which masked the nature of the surgical scar.

The study found that in terms of effectiveness, speed of recovery, hospital stay, time to get back to work and full activity, the keyhole method offered no advantage. However, the operation took more than half as long again to perform on average - 65 minutes against 40 minutes - and is likely to be more expensive.

Gall bladder removal is one of the commonest operations, and surgeons have adopted the new technique because it appeared to have "obvious advantages" which have not been proved in practice, Mr Ali Majeed, the surgeon who headed the study, said. That may, he suggested, have had much to do with manufacturers' investment in the instruments and imaging systems needed to perform it.

Such randomised studies account for less than 10 per cent of surgical research, The Lancet said, surgeons preferring simply to report a series of cases, an approach which tends to provide a more subjective comparison to existing methods.

The Lancet acknowledged difficulties in designing controlled trials for surgery, but a separate report showing the efficacy of a new Japanese operation for stomach cancer shows random studies can be done.

Surgeons must find ways to improve case series studies and to plan randomised trials, The Lancet's editor, Dr Richard Horton, said.