title: The impact of robotics on treatment of localized prostate cancer and resident education in Rochester, New York.
abstract: OBJECTIVE
  Robot-assisted radical prostatectomy (RARP) has been performed in Rochester, NY, since 2003. Currently, 10 area urologists perform RARP, and robotic training has become an important component of the residency. We present data describing the timeline for adoption, both in clinical practice and in the residency program.
  
  
  METHODS
  We reviewed the operating logs for all surgeons who were performing prostatectomies in all hospitals in Rochester, NY, from 2003 to 2007. We examined the influence RARP had on other treatments, including brachytherapy and cryotherapy. Surgical logs of graduating chief residents were also reviewed.
  
  
  RESULTS
  Eleven surgeons in Rochester regularly perform radical prostatectomy (10 perform primarily RARP, one performs only open prostatectomy). Three of the city's four hospitals have robotic systems. In 2003-2004, there were 30 open prostatectomies performed monthly and fewer than 10 performed robotically. By 2006, the trend was reversed, with 50 robot-assisted prostatectomies performed each month and fewer than 10 open prostatectomies (P<0.05). The rate of brachytherapy fluctuated, increasing in centers without a robot. The number of open prostatectomies in centers without a robot dropped significantly to fewer than 10 cases per year. There was also a significant decrease in the number of open prostatectomies performed by chief residents.
  
  
  CONCLUSIONS
  Since the introduction of surgical robotics, significant changes have been seen. The volume of radical prostatectomies performed by surgeons at institutions with robotics has increased; the volume at robot-free institutions has become nominal. There is a trend toward increased radiation therapy at robot-free institutions. While radical prostatectomies logged by graduating chief residents have increased, open prostatectomy experience is now minimal.
authors.affiliation: Polisseni Robotic and Minimally Invasive Surgery Center, Rochester General Hospital, Rochester, New York, USA.
authors.forename: Ralph
authors.initials: R
authors.lastname: Madeb
authors.forename: Dragan
authors.initials: D
authors.lastname: Golijanin
authors.forename: Joy K
authors.initials: JK
authors.lastname: Knopf
authors.forename: John
authors.initials: J
authors.lastname: Kowalczyk
authors.forename: Changyong
authors.initials: C
authors.lastname: Feng
authors.forename: Hani
authors.initials: H
authors.lastname: Rashid
authors.forename: Guan
authors.initials: G
authors.lastname: Wu
authors.forename: Louis
authors.initials: L
authors.lastname: Eichel
authors.forename: John R
authors.initials: JR
authors.lastname: Valvo
mesh_terms: D006801:Humans; D007396:Internship and Residency; D008297:Male; D009518:New York; D011468:Prostatectomy / Q000193:education* / Q000639:trends; D011471:Prostatic Neoplasms / Q000601:surgery*; D012371:Robotics / Q000193:education*; D013997:Time Factors