The impact of introducing laparoscopic radical prostatectomy on surgical wait times for prostate cancer

Wait times for radical prostatectomy are increasing in Canada. However, the impact of adopting a new surgical technique, such as laparoscopic radical prostatectomy (LRP), is not known. We outline the determinants of surgical wait time, the potential impact of adopting LRP and ways to minimize the impact. Surgical wait time is determined by surgical demand (number of people wanting surgery) relative to supply (number of surgeries a centre is able to offer). The introduction of any new technique will at first prolong operative times, but the degree to which it does is dependent on the learning curve of the surgeon and perioperative team. The influence of this learning curve on wait times depends on surgeon-level factors including case selection, triaging and scheduling tendencies, as well as hospital-level factors such as the amount and flexibility of operating room and hospital resources. The impact of adopting new technology may be minimized by the following: one surgeon per group initially learns the new procedure; the group and learning surgeon continue to offer the conventional procedure; early procedural experiences with the new technique are made as homogenous as possible; and a constant, dedicated team is created. Thus, the potential benefits of new techniques like LRP may be realized when adopted in a way that minimizes a negative impact on surgical wait times.