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ing prostate removals decreased from 10,000 to 8,200. The authors
suggested that as more high-volume surgeons adopted the technology,
those who performed only a few cases a year stopped altogether.
Mani Menon, MD, director of the Vattikuti Urology Institute at Henry
Ford Health System in Detroit, is one such surgeon. "We did 40 con-
secutive cases over 10 years ago, but we had to discontinue, because
insurance companies would not cover it," he says.
Urology's great debate
Robotically assisted radical prostatectomy, also known as RARP, aims
to eliminate cancer and preserve function. It is associated with mini-
mal bleeding, minimal pain and quick recovery.
The emerging standard for RARP is a 23-hour stay, as Elizabeth
Wein, MPS, RN, CNOR, director of surgical services at St. Clare's
Health System in New Jersey explains. "The post-operative care is
rather routine in these patients," she says. "It is considered ambulato-
ry surgery from a reimbursement standpoint, but we do keep the
patients overnight."
Robert Reiter, MD, director of the UCLA Prostate Cancer Treatment
and Research Center, is one of the few doctors who will do same-day
RARP. He says a patient well suited to the procedure is highly motivat-
ed to not spend a night in the hospital and to comply with post-opera-
tive instructions. He's relatively young (40s) and his prostate cancer is
in the early stages. Even at that, as an outpatient procedure RARP
requires one extra pre-operative step: a magnetic resonance imaging
(MRI) the day before the surgery to pinpoint the exact location of the
cancer.
A few years ago, surgeons at the Mayo Clinic in Arizona performed a
series of same-day RARP operations, although they've since stopped
doing the procedure, explains Erik Castle, MD, director of urologic
U R O L O G Y
