Laparoscopy in German Urology: Changing Acceptance among Urologists

Abstract

BackgroundLaparoscopic techniques have dramatically influenced urologic surgery in the past 2 decades. ObjectivesA questionnaire was distributed in 2006 to analyse laparoscopic practice patterns in Germany. The results were compared with a survey performed in 2002. Design, setting, and participantsIn 2006, 324 German urology departments received a detailed, anonymous, and self-administered questionnaire regarding demographic data, current use, and attitudes concerning laparoscopy. Quantitative evaluation of laparoscopic procedures was performed for 20 indications. MeasurementsThe response rate was 73% (238 of 324 institutions). Thirty-two responders were affiliated with universities; 95 responders were affiliated with urban hospitals; 101 responders were affiliated with general hospitals; and 9 responders were affiliated with private hospitals. Laparoscopy had been implemented as a standard operating procedure in 82% of the departments, an increase of 28% compared with the 2002 questionnaire. Forty-eight percent of participants expected a similar operating time to that of open surgery, an increase of 16% compared with the 2002 questionnaire. Concerns about the learning curve dropped from 92% in 2002 to 80% in 2006, and concerns about economic disadvantages dropped from 70% in 2002 to 45% in 2006. Criticism regarding lack of sufficient scientific data decreased from 76% in 2002 to 13% in 2006. Laparoscopic radical prostatectomies (>40 per year) were performed in 30 hospitals in 2006, an increase of 27% over 2002. Laparoscopic radical nephrectomy was performed 16–40 times per year in 33 of the responding institutions, an increase of 29% over 2002, and laparoscopic radical nephrectomy was performed >40 per year in 10 of the institutions, an increase of 9% over 2002. Laparoscopic pyeloplasty had a reported frequency of 16–40 procedures per year in 11 of the responding institutions, an increase of 10% over 2002, and laparoscopic pyeloplasty had a frequency between 5 and 15 procedures per year in 42 institutions, an increase of 37% over 2002. Only four hospitals performed cystectomy with ileum conduit and with orthotopic bladder substitute (5–15 cases per year). Results and limitationsThe results demonstrate the rising acceptance of laparoscopy in urologic surgery (an increase of 28% more departments performing laparoscopy) and an increasing interest in these techniques (an increase of 12% in the response rate). Their value is still limited by the response rate of only 73%. ConclusionsThis survey demonstrates the increasing impact of laparoscopy on surgical patterns in urology and the increasing acceptance of laparoscopic techniques concerning operating time, learning curve, and scientific approval.