Robot‐assisted radical prostatectomy in Aotearoa New Zealand: equity, quality, and workforce

Abstract

Robot-assisted radical prostatectomy (RARP) for prostate cancer is now well-established in settings where robotic surgical systems are available. The number of RARP per year overtook open radical prostatectomy (ORP) in 2009 in the United States of America (U.S.A), 1 in 2012 in England, 2 and in 2015 in Australia. 3 The proportion of RARP increased to 85% in the United States in 2013, 1 93% in England in 2018, 2 and 65% in Australia in 2019. 3 Similar trends have been observed in other advanced economies. [4][5][6] North Shore Hospital is the only public hospital in Aotearoa New Zealand (AoNZ) with a da Vinci Surgical System (dVSS) (Intuitive Surgical, Sunnyvale, California, USA), and its first RARP was performed in late 2021. Figure 1 outlines the trends for prostatectomy and new prostate cancer registrations in AoNZ from 2010 to 2020 using anonymous procedure-only data from the AoNZ distributor of the dVSS (Device Technologies, Auckland, New Zealand), the National Minimum Dataset for hospital events (National Collections and Reporting, Manat u Hauora, Ministry of Health) and publicly available new prostate cancer registrations from the New Zealand Cancer Registry. RARP comprised 10.5% (n = 90) of the total cases of radical prostatectomy in 2010/2011, rising to 27.6% (n = 436) in 2019/2020. The volume of RARP surpassed ORP in private hospitals in 2016/2017 and made up 60% of private radical prostatectomies in 2019/2020.Access to RARP in AoNZ has historically been through private health insurance or the ability to pay. NZ Health Survey data showed only a third of the population have private health insurance, with M aori and those living in lower deprivation areas less likely to have health insurance. 7 Only 23% of M aori and 19% of Pacific peoples reported having private health insurance compared to 37% of European/Other. This is likely reflected in the different treatment rates between M aori and European/Other for publicly funded prostate cancer therapy. 8 M aori and Pacific patients may derive additional benefits Fig. 1. Trend in and prostate cancer registrations. (Private hospital data on conventional laparoscopic radical prostatectomy prior to 2015 was poorly reported, and so excluded.

Robot-assisted general surgery in Aotearoa New Zealand

“…Most recent available figures show robot-assisted radical prostatectomy for prostate cancer comprised 28% of all radical prostatectomies in Aotearoa New Zealand for the 2019/2020 year, compared to only 11% in 2010/2011. 34 General surgery in Aotearoa New Zealand appears to be on the precipice, and international experience suggests that it is not only the fastest-growing category but also the highest volume. Until recently, access to RAS has only been available via private healthcare through the ability to pay and through having private health insurance.…”