Robot-assisted laparoscopic prostatectomy (RALP) is performed 5 times more than open radical prostatectomy (RP) and accounts for 85% of all RPs performed by urologists in 2013, a new study finds.
To determine practice patterns, Daniel T. Oberlin, MD, and colleagues from Northwestern University Feinberg School of Medicine in Chicago examined 6-month case logs from 6,563 urologists, or 2/3 of urologists in the United States certified by the American Board of Urology from 2003–2013. Of these, 68% had performed at least 1 RP in 6 months.
Relatively few surgeons performed a high volume of procedures, however. Overall, 39% of surgeons performed 2 or fewer open RPs within 6 months and 19% performed 2 or fewer RALPs. The median number of open RPs was 2 and RALPs, 8. The highest volume robotic surgeons performed 41% of RALPs. Open RP was more likely to be performed by lower volume surgeons.
Oncologists represented just 4.1% of surgeons but performed 15.1% of RP. General urologists performed the majority (57.8%) of RPs.
“The influence of surgeon volume on patient outcomes is a hotly debated topic in surgery today, with studies showing that surgeons who perform a low volume of specialized procedures per year have increased mortality, postoperative infections, and revision rates,” Dr. Oberlin and colleagues wrote in an online report in Urologic Oncology. They noted that the literature describes significant improvement in potency and continence when patients have procedures at high-volume centers. A minimal surgical volume for proficiency has yet to be established.
For unknown reasons, surgical approach influenced whether a prostate cancer patient received a pelvic lymph node dissection (PLND). With RALP, fewer general urologists performed a PLND than oncologists (25.9% vs. 47%); the researchers found no differences among subspecialists when PLND was performed open.
The findings corroborate trends found in previous research, such as a study published in the Journal of Urology (2012;187:2087-2092) by William T. Lowrance, MD, and colleagues that found increased adoption of RALP. The researchers also cited a survey published by Thomas D. Denberg, MD, and colleagues in BJU International (2007;99:339-343) showing 37% of urologists perform 10 or fewer RPs a year.
- Oberlin DT, Flum AS, Lai JD, Meeks JJ. The effect of minimally invasive prostatectomy on practice patterns of American urologists. Urol Oncol. doi:10.1016/j.urolonc.2016.01.008.