Survey of urological laparoscopic practices in the state of California

Purpose: In the interest of maintaining our surgical domain we performed a survey aimed at establishing laparoscopic practice patterns as they pertain to urological disease. Materials and Methods: Surveys were mailed to 2,902 surgeons in California who were listed with the American College of Surgeons, including 2,175 general surgeons, 510 urologists and 217 obstetricians-gynecologists. Results: A total of 442 complete responses (15.2%) were tallied. Of urologists and of nonurologists 54% and 11% performed no laparoscopy, while 12% and 80%, respectively, devoted at least 5% of their time to laparoscopic surgery. Urologists and nonurologists performing no laparoscopy were older than those performing a significant volume (p < 0.05). Of urologists 16% thought that they were trained adequately during residency to perform laparoscopic surgery compared with 30% of nonurologists. Of the urologists who performed hand assisted laparoscopy 50% tended to use it as a means of gaining familiarity with these techniques. These urologists performed more laparoscopic surgery than other urologists. While 80% of laparoscopy cases were community based, academic urologists are actively interested in laparoscopic surgery. The 2 most important reasons cited for performing laparoscopy were more rapid recovery and decreased morbidity. The leading laparoscopic procedures according to incidence for urologists performing laparoscopic surgery were diagnostic procedures (12.9%), varicocelectomy (12.1%), adrenalectomy (9.7%), pelvic lymphadenectomy (8.9%), and simple nephrectomy and renal cyst decortication (8.1% each). The leading laparoscopic cases according to the number of available cases per urologist were colposuspension-bladder neck suspension (1.06), donor nephrectomy (0.77), pelvic lymphadenectomy (0.52), varicocelectomy (0.48) and orchiopexy (0.45). Urologists performed more urological laparoscopy cases than nonurologists. Conclusions: Urological laparoscopic practice in California remains in its infancy. It is imperative that exposure should be increased in residency training programs.