Arguments against investing widely in robotic prostatectomy in Canada: a wrong focus on tool box rather than surgical expertise

Trends in urology resident exposure to minimally invasive surgery for index procedures: a tale of two countries

OBJECTIVE

To interrogate case-log data for American and Canadian urology residents to define trends in minimally invasive surgery (MIS) and open surgery and compare operative experiences between these 2 groups.

METHODS

Case-log data from 2004 to 2009 for American urology residents was compared with Canadian residents for 8 index cases, which are routinely performed in both an MIS and open approach. These included nephrectomy (donor, radical, simple, partial), prostatectomy (radical), adrenalectomy, pyeloplasty, and nephroureterectomy.

RESULTS

Linear regression analysis demonstrated a significant increase in the percentage of MIS radical prostatectomies performed by American residents (11.2%-52%), compared with Canadian residents (0.74%-11.2%). There was also a significant increase in the percentage of MIS donor nephrectomies by Canadian residents (5.6%-68.7%), compared with American residents (70.1%-89.1%). For Canadian residents, exposure to the following 3 MIS procedures increased significantly over open approaches: adrenalectomy, radical prostatectomy, and donor nephrectomy. For American residents, all index procedures with the exception of adrenalectomy underwent a significant increasing trend (all p < 0.05).

CONCLUSIONS

Trends for 8 index procedures confirm a continuing shift towards MIS for the majority of procedures in both countries. Differences may be only temporal and relate to dissimilar health care delivery models with a resultant lag in the adoption of laparoscopy and robotics in Canada. The impact of these trends upon ultimate surgical competence of graduates remains to be seen.

The training of Canadian urology residents: Whither open surgery?

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