Contemporary Open and Robotic Radical Prostatectomy Practice Patterns Among Urologists in the United States

Abstract

Purpose We describe current trends in robotic and open radical prostatectomy in the United States after examining case logs for American Board of Urology certification. Materials and Methods American urologists submit case logs for initial board certification and recertification. We analyzed logs from 2004 to 2010 for trends and used logistic regression to assess the impact of urologist age on robotic radical prostatectomy use. Results A total of 4,709 urologists submitted case logs for certification between 2004 and 2010. Of these logs 3,374 included 1 or more radical prostatectomy cases. Of the urologists 2,413 (72%) reported performing open radical prostatectomy only while 961 (28%) reported 1 or more robotic radical prostatectomies and 308 (9%) reported robotic radical prostatectomy only. During this 7-year period we observed a large increase in the number of urologists who performed robotic radical prostatectomy and a smaller corresponding decrease in those who performed open radical prostatectomy. Only 8% of patients were treated with robotic radical prostatectomy by urologists who were certified in 2004 while 67% underwent that procedure in 2010. Median age of urologists who exclusively performed open radical prostatectomy was 43 years (IQR 38–51) vs 41 (IQR 35–46) for those who performed only robotic radical prostatectomy. Conclusions While the rate was not as high as the greater than 85% industry estimate, 67% of radical prostatectomies were done robotically among urologists who underwent board certification or recertification in 2010. Total radical prostatectomy volume almost doubled during the study period. These data provide nonindustry based estimates of current radical prostatectomy practice patterns and further our understanding of the evolving surgical treatment of prostate cancer.

Robot-assisted versus laparoscopic nephroureterectomy for uppertract urothelial cancer: A population-based assessment of costs and perioperative outcomes

“…3 In the last 10 years, robotic surgery has emerged as an alternative minimally invasive surgical treatment for many malignancies, including urological cancers. 4,[23][24][25] In prostate cancer, robotic-assisted radical prostatectomy has overtaken the traditional open approach: 64% vs. 36% as of the year 2009, respectively. 25 In kidney cancer, robotic-assisted partial nephrectomy has also generated considerable interest, given its less prohibitive learning curve compared to the laparoscopic approach.…”

“…This trend is comparable to the use of robotics in other malignancies. 23,24 Robotic-assisted prostatectomy represents a noteworthy example of this phenomenon, where the utilization rate between 2005 and 2008 jumped by 60%, albeit with a decreasing incidence of prostate cancer. 27 The trends observed for RANU are most likely attributed to the aggressive marketing strategies and patient expectations, despite limited level 1 evidence efficacy data supporting its comparative effectiveness relative to traditional treatment modalities.…”

Robotic prostatectomy is associated with increased patient travel and treatment delay

“…Over the last 10 years, robotic-assisted radical prostatectomy (RARP) has become the most widely used surgical approach for prostate cancer (PCa) in the U.S. 1,2 Rapid adoption of robotic technology has caused increased RP use and centralization at high-volume centres. [3][4][5] These practice patterns have raised concerns about RP overuse on a population level and decreased access to care on a local-regional level.…”

“…[6][7][8] In the modern era of widespread use, the influence of RARP on access to care has not been investigated. 2 We examine how RP access has changed over time since robotic introduction and how robotic use has impacted access relative to other approaches in modern times.…”

Positive surgical margin rates during the robot-assisted laparoscopic radical prostatectomy learning curve of an experienced laparoscopic surgeon

“…Estimates from the United States suggest that 67% of patients undergoing radical prostatectomy had RARP in 2010, compared to only 8% in 2004. 1 The adoption of any novel surgical techniques is associated with a learning curve that may affect surgical quality. With progression along the RARP learning curve, improvements may be seen in various domains including operative time, estimated blood loss, positive surgical margin rate, urethrovesical anastomosis time, complications, length of hospital stay, transfusion rate, early continence, potency and conversion rate.…”