It is appreciated that market forces drove the rapid implementation of robotic assisted radical prostatectomy (RALP) in the US. The FDA approved RALP in 2000, but to date a randomized trial comparing RALP with open techniques has never been performed.
The study used the Wisconsin Inpatient Discharge database and identified patients who underwent retropubic prostatectomy (RP) between 2002 and 2008. The primary endpoint of the study was the quarterly surgical volume measured as the number of prostatectomies performed by each hospital in each of the 26 calendar quarters in the 6.5-year study period. Data was obtained about the acquisition of robotic technology and the date it occurred.
Fifty-two hospitals performed 10,021 prostatectomies in Wisconsin during the study period. Twelve hospitals (23%) acquired robotic technology by December 2007. The mean quarterly prostatectomy volume among adopter hospitals increased from 16.5 to 24.8 between 2002 and 2008 compared to a decrease of 4.5 to 3.1 among non-adopter hospitals. The proportion of all prostatectomies performed by hospitals that eventually acquired the robotic platform rose from 48.1% in the first quarter of 2002 to 72% in the second quarter of 2008. This suggests a centralization of prostatectomies by adopter hospitals. In 2007 the adopter hospitals’ mean quarterly prostatectomy volume was 22 with an interquartile range of 14 to 34 - suggesting substantial variability. For non-adopter hospitals, in 2007 the median quarterly prostatectomy volume was 3 with a interquartile range of 0 to 4. Acquisition of robotic technology was associated with a doubling of prostatectomy volume. They determined that 33.1% of men with CaP in Wisconsin underwent surgery in 2002, compared with 38.1% in 2006. This suggests that acquisition of surgical robots increased the overall use of prostatectomy in the context of CaP incidence in Wisconsin.
Neuner JM, See WA, Pezzin LE, Tarima S, Nattinger AB
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Cancer. 2011 Jun 29. Epub ahead of print.
10.1002/cncr.26271
PubMed Abstract
PMID: 21717434
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