The effect of minimally invasive prostatectomy on practice patterns of American urologists

Abstract

Introduction and objectives To determine how robotic prostatectomy affects practice patterns of urologists, we examined the case volume characteristics among certifying urologists for the surgical treatment of prostate cancer. We hypothesized that the utilization of open and robotic prostatectomy as well as lymph node dissection changed dynamically over the last 10 years. Methods Six month case log data of certifying urologists from 2003 to 2013 were obtained for the American Board of Urology. Cases were identified using CPT codes for open radical prostatectomy (ORP) and laparosopic or robotic-assisted laparoscopic prostatectomy (RALP) with a corresponding diagnosis of prostate cancer as defined by ICD-9 code 185.0. Results obtained A total of 6,563 urologists submitted case logs, of which 68% (4470/6563) reported performing at least one radical prostatectomy (RP), totaling 46,030 RPs logged. There was a 376% increase in the performance of RALP over the study period with robotic volume increasing from 22% of all RP in 2003 to 85% in 2013. Among surgeons performing ORP, the median number performed was 2; of surgeons who performed RALP, the median number performed was 8 (p < 0.001). 39% of surgeons logging ORP performed two or fewer RP while 19% of surgeons who performed RALP performed 2 or less RP (p < 0.001). The highest volume robotic surgeons (top 10% surgical volume) performed 41% of all RALP with the highest performing robotic surgeon recording 658 prostatectomies over 6 months. Oncologists represented 4.1% of all surgeons performing RP and performed 15.1% of all RP (p < 0.001); general urologists performed the majority of RP (57.8%). When performed open, there was no influence of surgeon specialty on the performance of lymph node dissection (LND); if performed robotically, oncologists were significantly more likely to perform LND compared to general surgeons (47% vs. 25.9% respectively, p < 0.001). Conclusions Robotic prostatectomies are performed five-times more commonly than open prostatectomy and represent 85% of all RP performed by board-certified urologists in 2013. Compared to RALP, ORP are significantly more likely to be performed by lower volume surgeons. Oncologists perform a higher relative percentage of RPs and are significantly more likely to perform LND if performed robotically when compared to general urologists.

Changing clinical trends in 10 000 robot‐assisted laparoscopic prostatectomy patients and impact of the 2012 US Preventive Services Task Force's statement against PSA screening

“…In the last decade, several factors including the increasing adoption of AS in patients with low‐risk prostate cancer, the USPSTF's recommendations against PSA screening, changing referral patterns, and increasing surgical experience with RALP have resulted in significant changes in the management of prostate cancer . RP has become the standard treatment in patients with localised and locally advanced prostate cancer, and >85% of RPs in the USA are today performed using robotic assistance . However, there is a paucity of data regarding the influence of changing clinical trends in prostate cancer on current RALP practice.…”

“…Radical prostatectomy (RP) is the standard of care for the management of localised prostate cancer and has evolved from open through laparoscopic to robot‐assisted laparoscopic RP (RALP) over the last decade . Today, >85% of RPs in the USA are performed using robotic assistance . RALP offers several advantages over traditional methods including decreased blood loss, shorter hospital stay, and less perioperative morbidity .…”

Predictive Factors of the Risk of Long-Term Hospital Readmission after Primary Prostate Surgery at a Single Tertiary Referral Center: Preliminary Report

“…In both of them, these complications occurred within 30 days after surgery due to massive pulmonary embolism (1 case; 50%) and heart failure (1 case; 50%). Discussion RP, particularly RARP, is the most common radical treatment for prostate cancer [3]. It is related with major and minor complications that can occur over the short and long term after hospital discharge.…”

“…Prostate cancer is the second most commonly diagnosed cancer in men, with an estimated 1.1 million diagnoses worldwide in 2012, accounting for 15% of all cancers diagnosed [1]. Although no active treatment modality has shown superiority over any other active management options in terms of survival [2], radical prostatectomy (RP), and specifically, robot-assisted RP (RARP) and has become the preferred surgical treatment in the United States [3]. However, as any surgery, it is related with perioperative and postoperative complications.…”

Robotisch assistierte obere gastrointestinale und hepatopankreatobiliäre Chirurgie: Etablierung durch einen Stepwise Approach und eine Analyse der ersten 100 Operationen

“…So werden bspw. in den USA bereits etwa 83 % aller radikalen Prostatektomien robotisch assistiert durchgeführt [14,15]. Die robotisch assistierte Oberbauchchirurgie befindet sich hingegen noch in der Anfangs-bzw.…”