title: Initiation of robot-assisted radical prostatectomies in Finland: Impact on centralization and quality of care.
abstract: Objective The aim of this study was to analyze the impact of introduction of robot-assisted prostate surgery and its quality measures in Finland from 2008 to 2012. Materials and methods Registry data were collected for time trends and national distribution of prostate cancer surgery in Finland, while preoperative, operative and follow-up data were collected for quality measures. Results The number and proportion of robot-assisted laparoscopic radical prostatectomies (RALPs) increased rapidly and they accounted for 68% of all radical prostatectomies in 2012. The number of centers performing prostatectomies diminished from 25 to 20 at the expense of low-volume centers. In total, 1996 patients were operated on in the four RALP centers in 2008-2012. As anticipated, the learning curve was uniform between the centers, as were mean blood loss (212 ml), hospitalization (1.8 days) and catheterization times (10.6 days). At 3 and 12 months, 49.4% and 71.2% of patients, respectively, were totally continent (no pads). After unilateral nerve-sparing surgery, 9.9% and 5.1% had partial or normal erection at 3 months postoperatively and 14.8% and 20.4% at 12 months, respectively. If bilateral nerve sparing was done, the figures were 13.0% and 13.5% at 3 months and 14.6% and 34.9% at 12 months. Clavien-Dindo grade 3, 4 or 5 complications were seen in 0.3%, 0.3% and 0.1% of patients, respectively. Limitations of the study include non-standardized collection of outcome parameters. Conclusions This report shows that the main impact of adoption of RALP on a national level was rapid spontaneous centralization of prostate cancer surgery. The main advantages of minimally invasive prostatectomy, i.e. low blood loss and short hospitalization, are easily achieved, while continuous effort is necessary for improvements in surgical outcomes.
authors.affiliation: a Department of Urology, Tampere University Hospital , Tampere , Finland ;
authors.forename: Jarno
authors.initials: J
authors.lastname: Riikonen
authors.affiliation: b Department of Surgery, Satakunta Central Hospital , Pori , Finland ;
authors.forename: Antti
authors.initials: A
authors.lastname: Kaipia
authors.affiliation: c Department of Urology, Helsinki University Hospital , Helsinki , Finland ;
authors.forename: Anssi
authors.initials: A
authors.lastname: Petas
authors.affiliation: d Department of Urology, Turku University Hospital , Turku , Finland ;
authors.forename: Antero
authors.initials: A
authors.lastname: Horte
authors.affiliation: a Department of Urology, Tampere University Hospital , Tampere , Finland ;
authors.forename: Juha
authors.initials: J
authors.lastname: Koskimäki
authors.affiliation: d Department of Urology, Turku University Hospital , Turku , Finland ;
authors.forename: Esa
authors.initials: E
authors.lastname: Kähkönen
authors.affiliation: d Department of Urology, Turku University Hospital , Turku , Finland ;
authors.forename: Peter J
authors.initials: PJ
authors.lastname: Boström
authors.affiliation: e Department of Urology, Oulu University Hospital , Oulu , Finland.
authors.forename: Ilkka
authors.initials: I
authors.lastname: Paananen
authors.affiliation: e Department of Urology, Oulu University Hospital , Oulu , Finland.
authors.forename: Jani
authors.initials: J
authors.lastname: Kuisma
authors.affiliation: c Department of Urology, Helsinki University Hospital , Helsinki , Finland ;
authors.forename: Henrikki
authors.initials: H
authors.lastname: Santti
authors.affiliation: c Department of Urology, Helsinki University Hospital , Helsinki , Finland ;
authors.forename: Mika
authors.initials: M
authors.lastname: Matikainen
authors.affiliation: c Department of Urology, Helsinki University Hospital , Helsinki , Finland ;
authors.forename: Antti
authors.initials: A
authors.lastname: Rannikko
mesh_terms: D000328:Adult; D000368:Aged; D003695:Delivery of Health Care / Q000458:organization & administration; D005387:Finland; D006801:Humans; D008297:Male; D008875:Middle Aged; D011468:Prostatectomy / Q000379:methods* / Q000592:standards*; D011787:Quality of Health Care; D012189:Retrospective Studies; D065287:Robotic Surgical Procedures
keywords: Prostate cancer; prostatectomy; robotics