Comparative analysis of global practice patterns in urologic robot-assisted surgery

Objectives: To determine and compare the status of urologic laparoscopic and robot-assisted surgery (RAS) across the world. Methods: Two hundred ninety-one surveys were completed by urologists at various national and international conferences in 2008. The 58-item questionnaire assessed the individual and institutional practice patterns of minimally invasive surgery with a focus on RAS. Surveys from Europe and North American continents (ENA) were compared with surveys from the Middle East and Asian continents (MEA). Results: One hundred sixty-six (57%) surveys were completed by urologists from MEA and 125 (43%) from ENA. Eighty percent of respondents performed minimally invasive surgery, with 64% having prior formal training. Respondents in ENA were more likely to have had formal training in RAS and performed more RAS cases (p<0.01). Sixty percent of those surveyed from ENA had used robotic consoles in training courses compared with only 20% in MEA (p<0.01). Dedicated RAS support teams were less common in MEA (p<0.01). Lack of a robotic system was the most common deterrent for RAS in MEA (56%). Respondents in ENA performed more robot-assisted radical prostatectomy, robot-assisted radical cystectomy, and robot-assisted nephrectomy. In the more established robotic environment of ENA, robot-assisted radical prostatectomy, robot-assisted radical cystectomy, and robot-assisted nephrectomy represented the gold standard in 34%, 14%, and 26% of surveys, respectively. Comparatively, MEA respondents were more likely to believe RAS represented the gold standard. Conclusions: Usage of RAS in urology continues to grow across the globe, though to most it represents a surgical alternative rather than benchmark. Even with reduced exposure, training, and access, more urologists in the MEA considered RAS to be the surgical standard for prostatectomy, cystectomy, and nephrectomy. The evolution of attitudinal change should be the focus of further study.