258 Background: The adoption of the da Vinci Surgical System (Intuitive Surgical, Inc) for robotic surgery requires a substantial financial investment by hospitals, acquisition of new surgical skills by surgeons, and demand from patients. Although the benefits of this technology have been previously described, the prevalence and adoption rate for the treatment of prostate cancer is not currently known. We performed a population-based analysis to determine how the introduction of robotic technology has altered the surgical management of prostate cancer. Methods: We analyzed patient-level data from the Prospective Rx Comparative Database (Premier, Inc., Charlotte, NC), which collects data from over 600 non-federal hospitals throughout the United States. We captured all men who underwent a radical prostatectomy between January 1, 2003, and December 31, 2010, based on the International Classification of Disease, 9th edition. Radical prostatectomies utilizing the da Vinci Surgical System were identified by a detailed review of the hospital charge data. Descriptive analysis with univariate and multivariate statistical analyses were performed. Results: Prior to 2006, <10% of radical prostatectomies were performed with robotic surgery. Beginning in 2006 there was a rapid rise in adoption reaching 56% utilization in 2009 and leveling off in 2010 to 54%. Adjusted analysis demonstrated that the odds of adopting robotic surgery were higher in teaching hospital (odds ratio [OR] 1.45, p<0.001) and hospitals in the Northeast (vs Midwest [OR 2.99, p<0.001]). Smaller hospitals (<200 beds) had a lower likelihood of adopting robotic surgery (OR 0.4, p<0.001). Patient age had no impact on the odds of undergoing robotic radical prostatectomy. Conclusions: Over past 5 years, there has been widespread adoption of robotic surgery in the management of prostate cancer now with just over half of procedures performed with the da Vinci Surgical System. Our analysis suggests that the adoption of robotic surgery has been determined primarily by the acquisition of this technology by hospitals, which was more common in teaching institutions, larger hospitals, and hospitals in the Northeast.
Transperineal single-port robot-assisted radical prostatectomy with Si da Vinci surgical system: initial experience and description of technique