Presentation Authors: Suzanne B. Merrill*, Brian S. Sohl, Hershey, PA, R. Houston Thompson, Rochester, MN, Adam Reese, Philadelphia, PA, Dipen J. Parekh, Miami, FL, John Lynch, Washington, DC, Baruch Grob, Richmond, VA, Daniel H. Williams, Madison, WI, Richard Lee, New York, NY, Stanley Zaslau, Morgantown, WV, Thomas Guzzo, Patrick J. Shenot, Philadelphia, PA, Erik Lehman, Jay D. Raman, Hershey, PA
Introduction: Completion of a minimum number of index procedures is required for urology residency graduation. Interestingly, no thresholds are stipulated regarding the surgical technique utilized. Therefore, it is unclear if the distribution between robotic and open technique learning is balanced for the trainee. To evaluate this question, we assessed the distribution of robotic and open surgeries performed by residents upon graduation.
Methods: We obtained voluntary ACGME graduated resident case logs between 2011-2017 from 11 academic institutions. These dates were selected as the ACGME began coding robotic cases separately in 2011. Data was de-identified and trends in robotic and open major surgeries (reconstructive, oncologic and pediatric) were compared using Wilcoxon Rank Sum tests.
Results: 136,868 major surgical cases were recorded by 209 graduating residents from 2011-2017. The median proportion of robotic cases increased from 2011 to 2017 across all major surgery (14.2% to 26.7%); reconstructive (2.9% to 9%); oncologic (27% to 54.2%); and pediatric (0% to 1.6%) (p for all < 0.001). Distribution trends over time are shown in Figure 1. Pediatric urology demonstrated the most blunted trend with a median of 3 robotic cases (IQR 0, 24) compared to 184 open cases (IQR 69, 379) being performed in 2017. Similar observations occurred in reconstructive urology. Conversely, in urologic oncology, the number of robotic procedures superseded that of open starting in 2016. The driver of this trend is likely robotic prostatectomy with the median number of robotic cases per graduating resident rising above that of open cases starting in 2012 (robotic: 57 (IQR 10, 163) vs. open: 46 (IQR 7, 256)) and showing a continual rise to 2017 (robotic: 81 (IQR 38, 189) vs. open: 22 (IQR 4, 52)).
Conclusions: Robotically preformed cases by graduating urology residents are increasing across all major surgical categories. However, the balance of technique utilized and the pace at which this distribution is changing vastly differs among reconstructive, oncologic and pediatric surgery. Continued evaluation is necessary, as such data may serve as a platform for determining if surgical technique standards are needed to maintain training integrity.