Article of the week: The survey says: surgeon preferences during robot-assisted radical prostatectomy

Every week the Editor-in-Chief selects the Article of the Week from the current issue of BJUI. The abstract is reproduced below and you can click on the button to read the full article, which is freely available to all readers for at least 30 days from the time of this post.

In addition to the article itself, there is an accompanying editorial written by a prominent member of the urological community. This blog is intended to provoke comment and discussion and we invite you to use the comment tools at the bottom of each post to join the conversation.

If you only have time to read one article this week, it should be this one.

The European Association of Urology Robotic Urology Section (ERUS) survey of robot-assisted radical prostatectomy (RARP)

Vincenzo Ficarra¹, Peter N. Wiklund², Charles Henry Rochat³, Prokar Dasgupta⁴, Benjamin J. Challacombe⁴, Prasanna Sooriakumaran⁵, Stefan Siemer⁶, Nazareno Suardi⁷, Giacomo Novara¹ and Alexandre Mottrie⁸

¹Oncological and Surgical Sciences, Urology Clinic, University of Padua, Padua, Italy; ²Urology Laboratory, Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden; ³Multidisciplinary Centre of Robot-Assisted Laparoscopic Surgery, Générale-Beaulieu Clinic, Geneva, Switzerland; ⁴Department of Urology, Guy’s Hospital, London, UK; ⁵Department of Urology, Royal Surrey County Hospital, Guildford, UK; ⁶Department of Urology, Universitätsklinikum des Saarlandes, Homburg/Saar, Germany; ⁷Department of Urology, Vita-Salute University San Raffaele, Milan, Italy; and ⁸Department of Urology O.L.V. Clinic Aalst, Aalst, Belgium; EAU Robotic Urologic Section (ERUS) Scientific Working Group

Read the full article

OBJECTIVE

• To evaluate surgeons adherence to current clinical practice, with the available evidence, for robot-assisted radical prostatectomy (RARP) and offer a baseline assessment to measure the impact of the Pasadena recommendations. Recently, the European Association of Urology Robotic Urology Section (ERUS) supported the Pasadena Consensus Conference on best practices in RARP.

SUBJECTS AND METHODS

• This survey was performed in January 2012. A specific questionnaire was sent, by e-mail, to 145 robotic surgeons who were included in the mailing-list of ERUS members and working in different urological institutions.

• Participating surgeons were invited to answer a multiple-choice questionnaire including 24-items evaluating the main RARP surgical steps.

RESULTS

• In all, 116 (79.4%) invited surgeons answered the questionnaire and accepted to participate to the ERUS survey.

• In all, 47 (40.5%) surgeons performed >100 RARPs; 41 (35.3%) between 50 and 100, and 28 (24.1%) <50 yearly.

• The transperitoneal, antegrade technique was the preferred approach.

• Minimising bladder neck dissection and the use of athermal dissection of the neurovascular bundles (NVBs) were also popular.

• There was more heterogeneity in the use of energy for seminal vesicle dissection, the preservation of the tips of the seminal vesicle and the choice between intra- and interfascial planes during the antero-lateral dissection of the NVBs. There was also large variability in the posterior and/or anterior reconstruction steps.

CONCLUSIONS

• The present study is the first international survey evaluating surgeon preferences during RARP.

• Considering that the results were collected before the publication of the Pasadena recommendations, the data might be considered an important baseline evaluation to test the dissemination and effects of the Pasadena recommendations in subsequent years.