Current Status Analysis of the Prevalence and Regional Disparities of Robot-Assisted Laparoscopic Prostatectomy in Japan Using Diagnosis Procedure Combination Data

Abstract We investigated the prevalence and regional disparities in the adoption of robot-assisted laparoscopic prostatectomy (RALP) across Japan using Diagnosis Procedure Combination data. Introduction of the “da Vinci S HD Surgical System” marked a significant shift towards robotic surgeries in Japan; however, the initial high costs and lack of efficacy data posed barriers to its widespread adoption. By 2023, more than 570 da Vinci units were operational in Japan, highlighting the growing acceptance of robotic surgery despite these challenges. This study adopted a retrospective observational design and analyzed data from 2,857 urban and 4,184 regional hospitals across 47 prefectures in Japan. It focused on the number of RALP procedures, da Vinci systems, and certified urological surgery proctors to assess disparities between urban and regional settings. Multiple regression analysis was used to identify the significant factors influencing RALP adoption. Urban areas were found to have a higher prevalence of RALP procedures and da Vinci systems, with urban hospitals performing 937 RALP procedures compared to 195.5 in regional hospitals. The analysis also revealed significant urban-regional disparities in access to robot-assisted surgery, with urban areas housing more da Vinci systems and hospitals performing RALP. The findings highlight a pronounced urban-regional disparity in RALP implementation, attributed to uneven access to advanced medical technologies and specialist training. Urban centers benefit from better access, leading to more RALP procedures. This study calls for policies to promote the dissemination of robotic surgery technologies and enhance specialist training in regional cities.