The role of early adopter bias for new technologies in robot assisted laparoscopic prostatectomy.
OBJECTIVE
We determined the potential influence of an early adopter bias in patients undergoing robot assisted laparoscopic prostatectomy.


METHODS
We compared baseline demographic, clinical and health related quality of life characteristics of patients undergoing 3 different surgical procedures for clinically localized prostate cancer following the introduction of robot assisted laparoscopic prostatectomy at our institution. Patients included in this analysis were participating in a prospective health related quality of life study using the SF-12(R) and Expanded Prostate Cancer Index Composite validated questionnaires.


RESULTS
Of 402 patients 159 (39%) underwent robot assisted laparoscopic, 144 (36%) underwent radical perineal and 99 (25%) underwent radical retropubic prostatectomy. There were no statistically significant associations between procedure type and patient age (p = 0.267), race (p = 0.725), number of medical comorbidities (p = 0.490), income (p = 0.056) and level of education (p = 0.495). Mean prostate specific antigen was 5.9 +/- 3.3, 7.3 +/- 5.5 and 5.7 +/- 5.0 ng/ml for robot assisted laparoscopic, radical perineal and radical retropubic prostatectomy, respectively (p = 0.030). The proportion of robot assisted laparoscopic, radical perineal and radical retropubic prostatectomy patients with a final Gleason score of 4-6 was 55%, 45% and 39%, respectively (p = 0.037). The proportion of robot assisted laparoscopic, radical perineal and radical retropubic prostatectomy patients with stage T2 disease was 91%, 68% and 80%, respectively (p = 0.001). Statistically significant associations of higher income and education with higher baseline health related quality of life scores were seen in the sexual and physical domains (each p <0.01).


CONCLUSIONS
We failed to find evidence of an early adopter bias for patients undergoing robot assisted laparoscopic prostatectomy. Nevertheless, observational studies comparing robot assisted laparoscopic prostatectomy to radical perineal and radical retropubic prostatectomy should account carefully for patient baseline characteristics to allow meaningful comparisons of surgical outcomes.
Tseng
Timothy Y
TY
Division of Urologic Surgery and Duke Prostate Center, Duke University Medical Center, Durham, North Carolina, USA.
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Quinton V
QV
Fesperman
Susan F
SF
Kuebler
Hubert R
HR
Sun
Leon
L
Robertson
Cary N
CN
Polascik
Thomas J
TJ
Moul
Judd W
JW
Vieweg
Johannes
J
Albala
David M
DM
Dahm
Philipp
P
D000368:Aged; D015982:Bias; D006801:Humans; D010535:Laparoscopy / Q000706:statistics & numerical data*; D008297:Male; D008875:Middle Aged; D011468:Prostatectomy / Q000379:methods* / Q000706:statistics & numerical data*; D012371:Robotics / Q000706:statistics & numerical data*; D013997:Time Factors