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Comment & Response
September 2016

Do Surgeons or Hospital Economics Ultimately Decide Operative Approach?

Author Affiliations
  • 1Department of Urology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
JAMA Surg. 2016;151(9):883-884. doi:10.1001/jamasurg.2016.0830

To the Editor We commend Wright and colleagues1 on their assessment of several external, nonmedical factors associated with the use of robotic-assisted surgery (RAS). In their study,1 3 urologic procedures were included. They demonstrated that robotic-assisted laparoscopic prostatectomies were performed in a greater percentage of cases (67.6%) than robotic-assisted laparoscopic nephrectomies (6.8%) and robotic-assisted laparoscopic partial nephrectomies (34.2%). As hypothesized, after regression analysis, hospital competition and financial status were associated with use of RAS. However, among hospitals already owning a robot, this effect dissipated. Given these findings, we would like to offer 2 additional points of consideration relative to the study’s results: (1) the apparent differential adoption and diffusion of RAS among the 3 procedures and (2) the benefits of technology relative to the surgical learning curve.

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