Development of urologic laparoscopy in Germany, Austria, and Switzerland: a survey among urologists.
OBJECTIVE
Laparoscopy introduction has dramatically changed urology. Novel techniques, such as laparoendoscopic single-site surgery (LESS) and natural orifice translumenal endoscopic surgery (NOTES), might also have substantial influence. This 2012 survey evaluated present laparoscopy use, its appraisal among urologic surgeons, laparoscopy training, and use of new techniques. Results were compared to the previous surveys, demonstrating the 10-year development of laparoscopy.


METHODS
A detailed questionnaire regarding demographic data, laparoscopy use, attitudes concerning laparoscopy, and novel techniques was send to 424 departments in Germany, Austria, and Switzerland. Procedures performed in 25 indications were quantitatively evaluated.


RESULTS
The response rate was 63 % (269). Eighty-six percent of the respondents reported performing laparoscopy, compared to 54 % in 2002. Only 16 % expected economic advantages with laparoscopy, whereas 67 % expected shorter hospitalization. Seventy percent of responders anticipated comparable functional and oncological results between laparoscopic procedures and open surgery. Slow learning curves (81 %) and insufficient training facilities (32 %) were reported to impair laparoscopic surgery. On average, laparoscopic and non-laparoscopic surgical teams consisted of 2.5 and 3.5 members, respectively. LESS procedures were performed at 15 % of institutions. Twenty-two percent of respondents considered NOTES techniques valuable for future urology. Few indications (laparoscopic prostatectomies or nephrectomies) were performed frequently in specialized centers, and the rapidly increasing procedure numbers observed between 2002 and 2007 had dropped to a mild accretion. The results demonstrate broad acceptance of laparoscopy in German urologic surgery, depict the need for structured training facilities, and indicate limited impact of novel techniques (LESS and NOTES).


CONCLUSIONS
The survey demonstrates the 10-year development of urologic laparoscopy and the broad acceptance of laparoscopic techniques.
Department of Urology and Urological Oncology, Hannover Medical School, Carl-Neuberg-Str. 1, 30625, Hannover, Germany.
Florian
F
Imkamp
Thomas R W
TR
Herrmann
Jens U
JU
Stolzenburg
Jens
J
Rassweiler
Tullio
T
Sulser
Uwe
U
Zimmermann
Sebastian
S
Dziuba
Markus A
MA
Kuczyk
Martin
M
Burchardt
D000328:Adult; D001291:Attitude of Health Personnel; D001317:Austria; D005260:Female; D005858:Germany; D006801:Humans; D010535:Laparoscopy / Q000193:education / Q000379:methods / Q000706:statistics & numerical data; D059032:Learning Curve; D008297:Male; D008875:Middle Aged; D057605:Natural Orifice Endoscopic Surgery; D018579:Patient Selection; D010818:Practice Patterns, Physicians'; D011795:Surveys and Questionnaires; D013557:Switzerland; D013520:Urologic Surgical Procedures; D014572:Urology