Trends in the practice of renal surgery for cancer in France after the introduction of robotic-assisted surgery: data fr
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LETTER TO THE EDITOR
Trends in the practice of renal surgery for cancer in France after the introduction of robotic‑assisted surgery: data from the National Health Care System Registry Idir Ouzaid1,2,3 · Jean‑Christophe Bernhard1,2 · Pierre Bigot1,2 · François‑Xavier Nouhaud1,2 · Jean‑Alexandre Long1,2 · Romain Boissier1,2 · Pierre Gimel1,2 · Thomas Bodin1,2 · Jean‑François Hetet1,2 · Arnaud Méjean1,2 · Laurence Albiges1,2 · Karim Bensalah1,2 · on behalf of the kidney cancer working group of the cancer committee of the French · Association of Urology and The UroCCR Network Received: 18 March 2020 / Accepted: 2 April 2020 © Springer-Verlag London Ltd., part of Springer Nature 2020
Keywords Renal cell carcinoma · Partial nephrectomy · Radical nephrectomy · Treatment · Surgery · Minimally invasive · Robotic surgery · Laparoscopic surgery To the editor, Partial nephrectomy (PN) is the standard of care treatment for cT1 renal masses and selected cT2 when technically feasible [1, 2]. Conventional laparoscopic partial nephrectomy can be technically challenging [3, 4]. The advent of robotic assistance allowed the spread of the minimally invasive approach. Robotic-assisted partial nephrectomy (RALPN) is currently considered the gold standard minimally invasive approach for PN by many experts in the field. In the last decade, France witnessed a nationwide increase in the Da Vinci™ (Intuitive Surgical™, Sunnyvale, CA, USA) robotic system implementations (n = 174) both in public and private institutions. Given this evolving landscape, we aimed to assess the national evolution of renal surgery practices after the introduction of the robotic-assisted surgery. Renal surgery procedures data from 2009 and 2015 were obtained by querying the database of the Agence technique de l’information sur l’hospitalisation (ATIH) hosted by the French Health System. The Common Classification of * Idir Ouzaid [email protected] 1
Association Française d’Urologie, Comité de cancérologie, 17 rue Viète, 75017 Paris, France
2
CHU de Bordeaux-Direction générale, 12 Rue Dubernat, 33400 Talence, France
3
Department of Urology, Bichat Claude Bernard Hospital, 46, rue Henri Huchard, 75018 Paris, France
Medical Procedures (CCAM) was used to extract data of partial nephrectomy (PN) versus radical nephrectomy (RN), open (OPN/ORN) versus laparoscopic (LPN/LRN)/robotassisted (RAPN) surgery. So far, a specific reimbursement coding for RAPN is not available. All minimally invasive PN were coded as LPN including the conventional LPN and RAPN. Da Vinci™ System being the unique device available, true conventional LPN was calculated as follows:
LPNReal = LPNATIH Database − RALPNIntuitive Surgical Registry . Intuitive Surgical™ registry is an anonymous prospectively maintained database. The International Classification of Disease (ICD-10) code C64 for kidney cancer was used to filter cancer-related procedures only. Since 2011, there are more than 9000 procedures performed yearly. There is a significant and continuous decrease of open surgery (tota
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