Boston—The use of robot-assisted simple prostatectomy (RASP) is increasing for the management of BPH in the United States. Patients were nearly seven times more likely to undergo RASP in 2011-2015 compared to 2003-2006, after adjusting for confounders.
“The robotic approach has gained steady traction across the years, from 1.5% in 2003 to over 10% in 2015, overtaking pure laparoscopy as the main [minimally invasive surgical] method of performing simple prostatectomy in the United States in 2010,” said Jeffrey Leow, MBBS, MPH, at the AUA annual meeting in Boston.
The analysis found that “there was also a decreasing trend in number and proportion of open simple prostatectomies” said Dr. Leow, urology resident at Tan Tock Seng Hospital, Singapore, and research fellow at the Center for Surgery and Public Health, Brigham and Women’s Hospital, Boston, working with Jesse Sammon, DO, and co-authors.
The growing popularity of holmium laser enucleation of the prostate (HoLEP) probably explains the stable rate of total simple prostatectomies over the study period. Guidelines from the AUA in 2014 and the European Association of Urology in 2017 for men with symptomatic BPH recommend simple prostatectomy or HoLEP, especially for prostate volumes >80 grams.
The effect of the advent of robotics on the use of simple prostatectomy in an era of growing popularity of enucleation was assessed by data extraction from the Premier Healthcare Database.
A total of 43,731 men who underwent simple prostatectomy for BPH at 414 U.S. hospitals between the first quarter of 2003 through the third quarter of 2015 formed the study population. Men diagnosed with prostate cancer were excluded. Using a combination of ICD-9 codes and a detailed review of the billing codes, procedures were identified as robotic or laparoscopic. Prostatectomy was performed via open procedure in 40,995 cases, via laparoscopic approaches in 1,348 cases, and via robotic technique in 1,388. The primary outcome of interest was the use of RASP over the study period.
Potential confounders were adjusted for and accounted for clustering by hospitals and survey weighting to ensure nationally representative estimates.