Background:
Radical prostatectomy, historically one of the major open surgical procedures in urology, has been increasingly performed with the use of the DaVinci surgical robot. We examined the past 14 months of prostatectomy experience in our city and the implications of such a trend on urology resident education.
Methods:
We retrospectively reviewed the operating room records over 14 months at the four major local hospitals. We tracked the number of surgeries being performed in an open manner (O) and those being performed with the DaVinci robot (R). We looked at our graduating chief residents case logs over each of the past 4 years as well as national data on average prostatectomy numbers for graduating chief residents from the Urology RRC.
Results:
Our monthly numbers of open vs. robotic prostatectomies in all four hospitals have gone from 36/6 (O/R) in July 2003, to 6/31 in August 2004 (z test, p<0.0001). At hospitals with resident coverage, 69/85 (81%) prostatectomies were performed open in the first three months reviewed and 28/129 (22%) were performed open over the last three months. Over the last four years, our chief residents have performed an average of 94 radical prostatectomies as surgeon, placing them between the 70th and 90th percentile nationally. The 50th percentile has been 55-61.
Conclusions:
At our teaching hospitals, a shift in prostatectomy technique from 81% open to 22% open has occurred over the past 14 months. Our resident experience with open radical prostatectomy, although very strong in the past, has declined as well. Although minimum numbers of open cases required for competency have not yet been established, such efforts are rightfully underway. A similar shift at a program with average or below average numbers may result in residents graduating without competence in open prostatectomy.

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