Robotic surgery in urology and the situation in ours countrys

Nado Vodopija, Sandi Poteko

General hospital Celje, urological department, , Slovenia

Robot assisted laparoscopic radical prostatectomy (RALP) is nowadays a routine operative method in treatment of localized prostate cancer in USA and Europe. Mainly because of the economic reasons only the first steps has been made in using this method in less developed and undeveloped countries.

Numerous articles about advantages of robotic approach in comparison to open or laparoscopic radical prostatectomy have been published. Also many critical articles, that have been pointing out the lack of well-controlled single surgeon prospective studies comparing outcomes.

Objective: The objective of the study is to present our experiences and first yet incomplete results of RALP, performed in Celje, as well as the costs of such procedures in Slovenia and the estimation of costs in Croatia. Since May 2010 on the Urologic department of General Hospital Celje we have operated 280 patients with the localized or locally advance prostate cancer.

Results: In listed period we have operated 280 patients with the localized or locally advance prostate cancer. Gathered have been incomplete results at 160 patients. The average operative time has been 186 minutes (90 – 330 min), the average blood loss has been 185 ml. Positive surgical margin (PSM) has been noticed at 25% of patients. We don’t have results of preserved potency yet and understandably longer oncologic results.

Financial results: The state health Insurance in Slovenia covers 4.600€ / procedure. Cost at 100 operations for 1 procedure is 6.180€ (amortization, maintenance, instruments, etc.), at 200 it decreases to 4.230€ /procedure and at 250 operations to 3.800€ / procedure.

Conclusion: Period of 22 months is too short to make final conclusions about the outcomes of RALP, above all oncological results. On the other hand the period is long enough and the number of procedures performed sufficient to conclude that RALP is safe procedure with good oncologic results. The question that remains open is how to cover the costs of the operation in less developed countries.