Initiation of robot-assisted radical prostatectomies in Finland: Impact on centralization and quality of care

Abstract

Objective The aim of this study was to analyze the impact of introduction of robot-assisted prostate surgery and its quality measures in Finland from 2008 to 2012. Materials and methods Registry data were collected for time trends and national distribution of prostate cancer surgery in Finland, while preoperative, operative and follow-up data were collected for quality measures. Results The number and proportion of robot-assisted laparoscopic radical prostatectomies (RALPs) increased rapidly and they accounted for 68% of all radical prostatectomies in 2012. The number of centers performing prostatectomies diminished from 25 to 20 at the expense of low-volume centers. In total, 1996 patients were operated on in the four RALP centers in 2008-2012. As anticipated, the learning curve was uniform between the centers, as were mean blood loss (212 ml), hospitalization (1.8 days) and catheterization times (10.6 days). At 3 and 12 months, 49.4% and 71.2% of patients, respectively, were totally continent (no pads). After unilateral nerve-sparing surgery, 9.9% and 5.1% had partial or normal erection at 3 months postoperatively and 14.8% and 20.4% at 12 months, respectively. If bilateral nerve sparing was done, the figures were 13.0% and 13.5% at 3 months and 14.6% and 34.9% at 12 months. Clavien-Dindo grade 3, 4 or 5 complications were seen in 0.3%, 0.3% and 0.1% of patients, respectively. Limitations of the study include non-standardized collection of outcome parameters. Conclusions This report shows that the main impact of adoption of RALP on a national level was rapid spontaneous centralization of prostate cancer surgery. The main advantages of minimally invasive prostatectomy, i.e. low blood loss and short hospitalization, are easily achieved, while continuous effort is necessary for improvements in surgical outcomes.

Safe surgery in the elderly: A review of outcomes following robotic proctectomy from the Nationwide Inpatient Sample in a cross-sectional study

“…The appeal of the improved ergonomics seems to play a role but is difficult to validate [29]. Industry involvement with academic centers in the implementation of this device among training centers throughout the country, combined with the centralization of medical care, propels patients towards high volume large budget centers [26,[30], [31], [32]]. Patients themselves are contributing towards this trend as hospitals, and hospital systems, compete to maintain minimum procedure volumes.…”

A Retrospective Study of Erectile Function and Use of Erectile Aids in Prostate Cancer Patients After Radical Prostatectomy in Denmark

“…Our data show that men undergoing RP in Odense have approximately the same erectile outcome as men reported in other similar studies. Østby-Deglum et al 20 reported erectile recovery in 25% of men 1 to 6 years after robot-assisted laparoscopic prostatectomy (RALP), Riikonen et al 21 found that 25.7% could have intercourse with or without the use of PDE-5i at 1 year after RALP, and Haglind et al 22 reported 30% erectile recovery 12 months after RALP and 25% recovery after open RP irrespective of the surgical technique used. Our study compares well with these studies in geographic area, flow of operations, age, preoperative PSA, BMI, and proportion with cardiovascular comorbidity.…”

Prostate MRI added to CAPRA, MSKCC and Partin cancer nomograms significantly enhances the prediction of adverse findings and biochemical recurrence after radical prostatectomy

“…RALP was performed transperitoneally and the indication for extended lymphadenectomy was GS �4+3 or >5% risk of lymph node positive disease according to the Memorial Sloan Kettering nomogram [2,14]. The prostate specimens and lymph nodes were processed as described earlier [15].…”