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Initial experience with robotic-assisted laparoscopic radical prostatectomy in the Canadian health care system.

BACKGROUND
Robotic-assisted laparoscopic radical prostatectomy (RALRP) has gained popularity in the United States due to claims of its superior 3-dimensional magnified vision and improved manual dexterity for surgeons that shorten the learning curve and facilitate the transition from standard open radical prostatectomy to laparoscopic prostatectomy as a minimally invasive procedure. The Canadian health care system, however, faces unique challenges when dealing with the introduction of new technologies. We report the initial experience with the use of the da Vinci robot for RALRP at the University of Western Ontario.


METHODS
We retrospectively reviewed the records of the initial 30 cases of RALRP with a minimum of 6 months follow-up. Data included the surgical times of various operative segments from cases 1-15 and 16-30, perioperative complications, early oncology and early functional results.


RESULTS
The lack of dedicated resources initially led to sporadic and infrequent cases. Nevertheless, there was improvement in surgical proficiency with significant difference in operative times between cases 1-15 and 16-30. Perioperative complications, though significant, were commensurate with reported early experiences from other centres worldwide, which reflects the learning curve with RALRP.


CONCLUSION
Initiating a new surgical program that involves significant capital and maintenance costs, such as an RALRP program, within the Canadian health care system poses unique challenges for the surgical team. Nevertheless, our initial experience has encouraged us to proceed with the next phase of evaluation for the urological and oncological application of the technology.