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The impact of robotic surgery on the surgical management of prostate cancer in the USA

Chang SL, Kibel AS, Brooks JD, Chung BI.

Comment from Henk van der Poel: In the US, robotic prostatectomy was more likely to be applied in high volume (>24 cases yearly) institutes. The percentage of men treated in high volume centers increased to 45%.

BJU Int. 2014 Jun 23. doi: 10.1111/bju.12850. [Epub ahead of print]



To describe the surgeon characteristics associated with robot-assisted radical prostatectomy (RARP) adoption and determine the possible impact of this adoption on practice patterns and cost.


A retrospective cohort study with a weighted sample size of 489 369 men who underwent non-RARP (i.e., open or laparoscopic RP) or RARP in the USA from 2003 to 2010 was performed. We evaluated predictors for RARP adoption, defined as performing >50% of annual RP using the robotic approach. Additionally, we identified the resulting changes in prostate cancer surgery practice patterns and expenditures.


From 2003 to 2010, RARP adoption increased from 0.7% to 42% of surgeons performing RP. High-volume surgeons, defined as performing >24 RPs annually, had statically significantly higher odds of adopting RARP throughout the study period. From 2005 to 2007, adoption was more common among surgeons at teaching (odds ratio [OR] 2.4, 95% confidence interval [CI] 1.7-3.4), intermediate- (200-399 beds; OR 5.96, 95% CI 1.3-26.5) and large-sized hospitals (≥400 beds; OR 6.1, 95% CI 1.4-25.8); after 2007, adoption was more common among surgeons at urban hospitals (OR 3.3, 95% CI 1.7-6.4). RARP adoption was generally associated with increased RP volume, greatest for high-volume surgeons and least for low-volume surgeons (<5 RPs annually). The annual number of surgeons performing RP decreased from about 10 000 to 8200, with the proportion of cases performed by high-volume surgeons increasing from 10% to 45%. RARP was more costly, disproportionally contributing to the 40% increase in annual prostate cancer surgery expenditures. RARP costs generally decreased plateauing at slightly over $10 000, while non-RARP costs increased to nearly $9000 by the end of the study.


There was widespread RARP adoption in the USA between 2003 and 2010, particularly among high-volume surgeons. The diffusion of RARP was associated with a centralisation of care and an increased economic burden for prostate cancer surgery.

© 2014 The Authors. BJU International © 2014 BJU International.


diffusion of innovation; health expenditures; physician's practice patterns; prostatic neoplasms; robotics