Urology Clinical Fellow
Division of Urology
University of Montreal Health Center
Impact of growing multi-specialty use of robotic surgery on delivery of robotic urologic surgery in Canada: A 10-year review of 2 academic centers
Ahmed S. Zakaria Ahmed1, David-Dan Nguyen 2, Iman Sadri 2, Adel Arezki 2, Félix Couture3, Ali Abdullah 1, Ronald Denis 4, Assaad El-Hakim4, Kevin C. Zorn1.
1Department of Surgery, Division of Urology, Centre hospitalier de l’Université de Montréal (CHUM), Montreal, QC, Canada; 2Faculty of Medicine, McGill University, Montreal, QC, Canada; 3Department of Surgery, Division of Urology, McGill University Health Centre (MUHC), Montreal, QC, Canada; 4Department of Surgery, Division of Robotic surgery, Hôpital du Sacré Coeur de Montréal (HSCM), Montreal, QC, Canada
Introduction: The vast majority of robotic-assisted surgery (RAS) systems in Canada (30 robots) are donor-funded, with significant limitations on implementation and operation due to their cost that precludes their public coverage. This study aimed to characterize the impact of growing multi-specialty use of RAS on urological RAS outcomes during the last decade.
Methods: We conducted a retrospective review of all RAS performed by different surgical specialties in two high-volume academic centers between 2010 and 2019. The assessed outcomes included the effect of increased robot access over the years on annual robotic-assisted radical prostatectomy (RARP) volumes, surgical waiting times (SWT), and pathological positive surgical margins (PSM).
Results: In total, 6 specialties (urology, general, cardiac, thoracic, gynecology, and Otorhinolaryngologic surgery) developed RAS programs. RAS access by specialty doubled since 2010 (from 3 to 6). The number of active robotic surgeons tripled from 7 surgeons in 2010 to 20 surgeons in 2019. Over years, there was a significant drop in average case volume per active robotic surgeon (all specialties included) from a peak of 40 cases in 2014 to 25 cases in 2019 (Fig.1a). RARP annual case volume followed a similar pattern, reaching a maximum of 166 cases in 2014 then declining to 113 and 137 cases in 2017 and 2019, respectively. Furthermore, mean SWT increased from 52 days in 2014 to 73 days in 2019. PSM rates were not affected by the reduction in surgical volumes (Fig.1b).
Conclusion: Over the last decade, RAS access by specialty has increased at our academic center. There was a steady reduction in the number of RAS performed per surgeon over time as well as a gradual increase in the SWT. Relying on the current low number of robots and the non-sustainable funding resources might affect universal patient access to RAS. More national multispecialty studies are required to confirm results and inform future policy on RAS coverage and access.