Medical Student Research Fellowship for Summer 2008

Mentor: Dr. Yair Lotan
Department: Urology
Room number: J8.112
Mail Code: 9110
Phone number: 214-648-0389
E-mail: Yair.Lotan@utsouthwestern.edu
Project title: Introduction of Robotic Prostatectomy at an Academic Institution: Impact on outcomes, complications, cost effectiveness

Human subjects IRB approved project number (where applicable): 1203-756

Animal subjects IRB approved project number (where applicable):

Project Type: patient-based research

Brief Description of Project:

Prostate cancer is currently the most common malignancy in men with 186,320 new diagnoses projected in 2008.{American Cancer Society 2007 } The traditional surgical approach to treatment of prostate cancer has been open radical retropubic prostatectomy (RRP), however with the growth of minimally invasive surgical techniques, laparoscopic radical prostatectomy (LRP) and robotic assisted laparoscopic prostatectomy (RALP) have gained in popularity due to better visualization, reduced blood loss,1-4 more rapid postoperative convalescence1,4, and better cosmesis relative to RRP. Despite the advantages of RALP and LRP, there are still questions regarding the efficacy and cost due to longer operative times and use of expensive equipment. Given the large number of men diagnosed with prostate cancer and presumably seeking treatment, it is desirable that treatment options are not only efficacious but cost effective.
Previous studies have investigated this question using published operative data from multiple institutions to construct computer models to predict the costs of LRP, RALP and RRP. {Link, Su, et al. 2004 #3751}{Lotan, Cadeddu, et al. 2004 #3752} Still these models have not been validated using actual clinical cost data. The impact of introduction of a robotic system has also not been investigated to evaluate the economic impact of transitioning for RRP to RALP.
Our aims:
1) Determine cost effectiveness of Robotic Assisted Laparoscopic Prostatectomy (RALP) as compared to open surgeries
2) Examine the learning curve for RALP, outcome, positive margin rate, operative time, complication rate, and length of stay
3) Compare different surgical approach outcomes

We have cost data on 618 patients who underwent RRP, RALP and LRP over last 3 years at Zale Lipshy Hospital. We will obtain clinic data and correlate with financial data to investigate the cost-effectiveness of the robotic approach. We will also evaluate the impact of the learning curve on length or stay, complication rates, oncologic outcomes and cost.

REFERENCES
1. Bhayani SB, Pavlovich CP, Hsu TS, et al: Prospective comparison of short-term convalescence: Laparoscopic radical prostatectomy versus open radical retropubic prostatectomy. Urology 61: 612-616, 2003.
2. Anastasiadis AG, Salomon L, Katz R, et al: Radical retropubic versus laparoscopic prostatectomy: A prospective comparison of functional outcome. Urology 62: 292-297, 2003.
3. Roumeguere T, Bollens R, Vanden Bossche M, et al: Radical prostatectomy: A prospective comparison of oncological and functional results between open and laparoscopic approaches. World J Urol 20: 360-366, 2003.
4. Rassweiler J, Seemann O, Schulze M, et al: Laparoscopic versus open radical prostatectomy: A comparative study at a single institution. J Urol 169: 1689-1693, 2003.
5. Link RE, Su LM, Bhayani SB, et al: Making ends meet: a cost comparison of laparoscopic and open radical retropubic prostatectomy. J Urol 172: 269-274, 2004.
6. Lotan Y, Cadeddu JA, Gettman MT: The new economics of radical prostatectomy: Cost comparison of open, laparoscopic and robot assisted techniques. J Urol 172: 1431-1435, 2004.
7. Guillonneau B, Vallancien G: Laparoscopic radical prostatectomy: The Montsouris experience. J Urol 163: 418-422, 2000.

Previous Research Activities or Publications with Medical Students:

Bensalah K, Raman JD, Bagrodia A, Marvin A, Lotan Y.Does Obesity Impact the Costs of Partial and Radical Nephrectomy?J Urol. 2008 Mar 14

Yair Lotan1, Karim Bensalah1, Timothy Ruddell1, Shahrokh F. Shariat1, Arthur Sagalowsky1, Raheela Ashfaq2.
Prospective Evaluation of the Clinical Utility of Reflex Fluorescent In Situ Hybridization Assay in Patients with Atypical Cytology for Detection of Urothelial Carcinoma of the Bladder. J urol in press

Svatek RS, Lee D, Lotan Y. Correlation of Office-Based Cystoscopy and Cytology with Histologic Diagnosis: How Good is the Gold Standard? Urology. 2005 Jul;66(1):65-8.

Shariat SF, Herman MP, Casella R, Lotan Y, Karam JA, Stenman UH. Urinary Levels of Tumor-Associated Trypsin Inhibitor (TATI) in the Detection of Transitional Cell Carcinoma of the Urinary Bladder. Eur Urol. 2005 Sep;48(3):424-31

Anderson JK, Murdock A, Cadeddu JA, Lotan Y. Cost Comparison of Laparoscopic versus Radical Retropubic Prostatectomy. Urology. 2005 Sep;66(3):557-60.

Svatek RS, Herman MP, Lotan Y, Casella R, Hsieh JT, Sagalowsky AI, Shariat SF. Soluble Fas-A promising novel urinary marker for the detection of recurrent superficial bladder cancer. Cancer. 2006 Mar 15.

Park S, Jaffer O, Lotan Y, Saboorian H, Roehrborn CG, Cadeddu JA. Contemporary laparoscopic and open radical retropubic prostatectomy: pathologic outcomes and Kattan postoperative nomograms are equivalent. Urology. 2007 Jan;69(1):118-22.