To evaluate the differential activity in robotic-assisted laparoscopic surgery (RALS) by urologic surgeon gender.
This was a retrospective study of American Board of Urology surgical case logs from 2012-2022. The CPT-coded laparoscopic procedures included were: Partial Nephrectomy (50543), Radical Nephrectomy (50545, 50546, 50548), Pyeloplasty (50544), and Sacrocolpopexy (57425). Robotic-assisted cases were co-coded with CPT S2900. Univariate analysis and multiple logistic regression analyzed the roles of physician gender and other factors on RALS utilization. A separate analysis was performed for Robotic-Assisted Laparoscopic Prostatectomy (RALP) (55866).
Women performed 10.8% of all procedures and 9.02% of robotic cases. General Urology and Urogynecology and Reconstructive Pelvic Surgery (URPS) had higher concentrations of women. Of the CPT procedures analyzed, women performed the highest percentage of sacrocolpopexies (39.2% of total), 8.09% of which were robotic. In multivariate regression, women surgeons had significantly lower odds of performing a robotic case compared to men (OR 0.803, p<0.001). Endourology, Oncology, Pediatric Urology, and URPS subspecialties were associated with RALS. Upward trends were depicted across all physicians (0.012, [0.007, 0.018], p<0.001) and for men (0.019, [0.010, 0.029], p=0.001). Women showed no significant increase in robotic usage over time (p=0.463).
Women have lower odds of participating in robotics, primarily specialize in URPS and their involvement in RALS is skewed toward sacrocolpopexy. As robotics continues to dominate surgical urology, ensuring equitable training opportunities is essential. Research into the roles of mentorship in residency, same gender patient-physician concordance, practice setting, and recent graduates' referral patterns is warranted.
Urology. 2024 Oct 18 [Epub ahead of print]
Alexa Steckler, Natalie Passarelli, Alexander Homer, Simone Thavaseelan, Elias Hyams
Minimally Invasive Urology Institute, The Miriam Hospital; The Warren Alpert Medical School of Brown University. 164 Summit Ave, Providence, RI 02906, USA. Electronic address: ., Minimally Invasive Urology Institute, The Miriam Hospital; The Warren Alpert Medical School of Brown University. 164 Summit Ave, Providence, RI 02906, USA., The Warren Alpert Medical School of Brown University. 164 Summit Street, Providence, RI 02906, USA.