In 2023, among 10,100 robotic procedures performed in Poland, 73% were urological surgeries (with prostatectomy alone accounting for 69%).
Robotic surgery is developing very dynamically in Poland. In 2023, compared to the previous year, the number of robotic systems used in Polish hospitals nearly doubled, while the number of robot-assisted surgeries nationwide increased by 109% (from 4,844 to 10,110). This growth is partly due to the emergence of 19 new centres (which collectively performed 1,537 procedures) but primarily results from the intensive development and increased number of procedures performed in hospitals that have been operating for several years.
In 2023, Da Vinci robot assisted procedures were performed in 45 hospitals, the Versius system was used in 13 hospitals, and one hospital operated with the Senhance system. We had been awaiting the introduction of other robotic systems, such as Medtronic’s Hugo, already in use in selected centres in Western Europe, or Japan’s Hinotori by Medicaroid, which is currently undergoing European certification.
In addition to general surgery systems (Da Vinci, Versius), the number of hospitals using specialist robotic systems in orthopaedics and neurosurgery is also rapidly increasing. In 2023, 14 facilities regularly used orthopaedic robots for knee or hip arthroplasty (the following systems were used: Rosa Knee System, Mako, Navio, Cori, OMNIBotics). The highest number of robotic arthroplasties were performed by SPZOZ in Ostrów Mazowiecka. Meanwhile, 7 hospitals used robotic systems for spine or brain surgery (systems: ExcelsiusGPS, Mazor X, Stealth Autoguide, Rosa Brain).
Leaders in Robotics
In 2023, the highest number of robot assisted surgeries were performed at the Silesian Urology Centre UROVITA in Chorzów. Ten surgeons using two Versius systems conducted a total of 638 procedures at the Chorzów hospital: 437 urological (including 374 prostatectomies) and 201 gynaecological (including 127 endometrial cancer surgeries). Additionally, UROVITA surgeons performed 18 procedures using one of their robots at the T. Chałubiński District Hospital in Zakopane. The second highest number of robotic surgeries were recorded at the Prof. F. Łukaszczyk Oncology Centre in Bydgoszcz, which has two Da Vinci systems and performed 500 procedures, including 354 prostatectomies, 56 endometrial cancer surgeries, 55 colorectal operations, and 35 thoracic surgeries. The third position, with 473 robot assisted procedures, was held by the Military Institute of Medicine, also using two Da Vinci systems. These included 123 prostatectomies, 94 gynaecological procedures, 67 gastrointestinal surgeries, 57 thoracic surgeries, as well as head and neck surgeries and cardiac procedures.
Among the 58 robotic surgery centres, 14 were private hospitals, but only 6 operated exclusively in the private sector without a contract with the National Health Fund (public payer). The number of procedures financed privately by patients declined for the second consecutive year, amounting to approximately 550 (compared to about 1,160 in 2021 and around 960 in 2022).
In 2023, in terms of population adjusted figures, the highest number of robotic procedures were performed in the Kuyavian-Pomeranian Voivodeship, with 62 surgeries per 100,000 inhabitants (compared to just 10 in 2022). The Mazovian Voivodeship ranked second with 52 surgeries per 100,000 inhabitants (up from 37 in 2022), followed by the Lublin Voivodeship with 36 surgeries per 100,000 inhabitants (compared to 11 in 2022). The national average in 2023 were 27 robotic procedures per 100,000 inhabitants, double the 2022 figure of 13.
In the ranking of hospitals performing the most robot assisted surgeries in 2023, the top three institutions all operated with two robotic systems. However, the number of procedures performed by the two best hospitals using only a single robot is noteworthy: the University Clinical Hospital in Rzeszów (422 surgeries) and the University Clinical Hospital No. 2 of the Pomeranian Medical University in Szczecin (410 surgeries). Close to this level in 2023 was another institution – the National Medical Institute of the Ministry of the Interior and Administration (387 operations).
The number of procedures performed annually with a single system is a reliable indicator of the efficiency of robotic surgery implementation. The highest efficiency in Polish conditions has so far been achieved by Medicover Hospital, which set an unbeaten national record in 2019 with 423 surgeries. Notably, all these procedures (prostatectomies) were performed by a single surgeon, Paweł Salwa, MD, PhD. Up to 2023, 6 hospitals have managed to perform over 300 procedures in a single year using one robotic system. Four institutions have exceeded 400 procedures per year with a single robot: Medicover Hospital (twice: 423, 413), University Clinical Hospital in Rzeszów (422), University Clinical Hospital No. 2 of the PUM in Szczecin (410), and the European Health Centre Otwock (407). Among the top 10 annual results, seven were achieved by private hospitals, including four times by Medicover Hospital, which operates exclusively in the private sector without a contract with the National Health Fund.
Urology remains the leader in robotic surgery
Among the 10,100 robotic procedures performed in Poland, 73% were urological surgeries (with prostatectomy alone accounting for 69%). Gynaecological procedures, almost exclusively in the field of gynaecologic oncology, constituted 12.2% (with uterine cancer surgeries making up 9.1%), while gastroenterological procedures, involving various sections of the colon affected by cancer, accounted for 8.5%. Only 5 hospitals equipped with surgical robots did not perform urological procedures in 2023 – Greater Poland Cancer Centre, Opole Cancer Centre, University Clinical Hospital No. 1 in Lublin, and University Clinical Centre of the SUM (where the study focused on other areas), and St. Vincent’s Hospital in Warsaw (due to a division of services within the LUX MED Group).
Over the past two years, the number of institutions performing robotic gynaecological and gastroenterological procedures has increased 2.5 fold; however, a much faster expansion is expected following the 2023 increase in reimbursement rates for robot assisted surgeries. The “market” potential for robotic system manufacturers in these fields is also greater than in urology. While approximately 140 hospitals in Poland perform prostatectomy or cystectomy, nearly 400 hospitals conduct colorectal surgeries, and nearly 250 facilities perform uterine surgeries annually. In urology alone, the total number of radical surgeries for prostate, kidney, and bladder cancer has recently reached around 17,000 per year.
In 2023, robot assisted urological procedures were performed in 53 Polish hospitals. A total of 7,424 surgeries were performed. Compared to 3,588 procedures in 2022, this represents a 107% increase. A total of 6,974 robotic prostatectomies were performed, making it still the most common robotic procedure, accounting for 69% of all robotic surgeries in Poland. The highest number of urological robotic procedures in 2023 were performed by the Silesian Urology Centre UROVITA in Chorzów (437 surgeries), while the most robot assisted prostatectomies were conducted at the European Health Centre Otwock The following were performed – 378 surgeries.
Robot assisted radical prostatectomy (RARP) has been the most commonly performed procedure in hospitals for years, both under National Health Fund (NFZ) contracts and in the private sector. In 2023, the proportion of robotic procedures among all prostatectomies exceeded 58%, with Poland closing the gap in this regard to Western European countries. In leading nations (Norway, United Kingdom, the Netherlands, Sweden, Denmark), nearly all prostatectomies are performed robotically, with other methods used only in exceptional cases. France surpassed the 50% threshold for robotic prostatectomy in 2021, meaning that Poland is only two years behind this country in terms of robotic surgery adoption.
Urologists perform the highest number of robotic surgeries
The growth of robotic surgery in terms of the number of hospitals and procedures is accompanied by the development of a specialist workforce trained in performing robot-assisted operations. In 2023, more than 200 surgeons in Poland performed robotic procedures. In 19 of the 20 largest hospitals (one facility did not provide data) that conducted at least 200 procedures that year, a total of 98 specialists operated, averaging 5.2 surgeons per hospital. The number of surgeons per hospital ranged from 2 to 10.
In 2023, seven surgeons in Poland performed over 200 robotic procedures, all of whom were urologists. The highest number of surgeries, 313, were performed by Prof. Tomasz Drewa at two institutions: the A. Jurasz University Hospital No. 1 in Bydgoszcz, and M. Kopernik Specialist Municipal Hospital in Toruń, primarily prostatectomies and cystectomies. Paweł Salwa, MD, PhD from the Medicover Hospital, ranked second with 252 robot assisted procedures; Tomasz Szopiński, MD, PhD ranked third with 246 surgeries performed at the Mazovia Hospital in Warsaw and the Silesian Urological Hospital in Katowice. Piotr Petrasz, MD, PhD performed slightly fewer procedures – 242 surgeries – at the Voivodeship Specialist Hospital in Gorzów Wielkopolski. Other surgeons who performed more than 200 robotic procedures include Krzysztof Kamecki, MD, PhD at The Oncology Centre in Bydgoszcz (205 surgeries), Łukasz Nyk, MD, PhD at European Health Centre Otwock (203 surgeries), and Paweł Wisz, MD, PhD (225 surgeries), operating in 2023 at 5 various institutions.
The analysis of these results reveals significant fragmentation and concerningly low numbers of procedures among most surgeons. The largest group of robotic surgeons, 33 individuals, performed no more than 20 surgeries. Another 30 surgeons completed between 21 and 40 procedures. Nearly half of all operators performed no more than 40 robotic procedures in 2023. However, it is worth noting that 22 surgeons performed fewer than 10 procedures per year, mainly due to being in the early stages of training in robotic surgery. This is a positive trend, indicating that hospitals are investing in education and workforce development.
Billing data from the National Health Fund further confirm that the average number of robotic procedures performed per surgeon in Polish hospitals remains low. In 2022, 112 doctors performed NFZ-funded robotic prostatectomies. In 2023, the number of robotic surgeons increased to 247, including 191 for prostate cancer, 37 for colorectal cancer, and 19 for endometrial cancer. Only 49 of them performed more than 50 robot assisted procedures in this period (from 1 April 2022 to the end of 2023).
Robotic urology is dominated by prostatectomy, but an increasing number of hospitals are performing robot assisted bladder surgeries (mainly cystectomies) and kidney procedures, primarily nephron-sparing surgeries. In 2023, 23 institutions performed a total of approximately 450 urological procedures other than prostatectomy. Among them were about 260 kidney surgeries, with the highest numbers recorded at the Silesian Urology Centre UROVITA (45), Międzylesie Specialist Hospital (44), and St. Ann’s Hospital in Piaseczno (39). Additionally, 12 institutions performed a total of approximately 110 robot assisted bladder surgeries – the highest number (22 procedures), was conducted at the A. Jurasz University Hospital in Bydgoszcz, followed by the John Paul II Voivodeship Hospital of Mazovia in Siedlce (20), the Silesian Urology Centre UROVITA (18), and Voivodeship Specialist Hospital in Wrocław (13 procedures).
Robotic surgery in prostate cancer
In Poland, a total of 11,975 radical prostatectomies were performed in 2023. Among them, 6,974 were robot assisted procedures, 3,612 were laparoscopic surgeries (30%), and 1,389 were open surgeries (12%). The National Health Fund reimbursed 11,400 prostatectomy procedures, while another 554 were privately funded by patients. Among the NFZ-funded surgeries, 5,448 were billed as robotic procedures. These data indicate that due to restrictions in NFZ regulations (and contract conditions), around 960 robotic prostatectomies were reimbursed at laparoscopic or open surgery rates.
The year 2023 marked the culmination of a revolution in urology with the expansion of minimally invasive techniques, particularly robotic surgery. The percentage of open prostatectomies, which accounted for more than half of procedures in 2018, dropped to just 12%, while robotic surgery approached 60%. The proportion of robotic procedures is expected to continue increasing in the near future, although this growth may be slowed by the continued fragmentation of surgical oncology treatment.
At the same time, there has been a rapid increase in the number of patients undergoing radical surgery. In 2021, the NFZ funded surgical treatment for 6,500 prostate cancer patients, with an additional 1,150 treated privately, bringing the total to approximately 7,650 patients. In 2022, this number increased to 9,900, and in 2023, it reached 12,000. The high level of reimbursement makes prostatectomy financially viable for hospitals, which has likely contributed to the rise in the number of surgeries. The lack of a registry prevents verification of concerns raised by some experts that patients who may not meet the criteria for radical treatment are being qualified for surgery.
However, the primary reason for the sharp increase in procedures is likely the growing incidence of prostate cancer. The most recent data from the National Cancer Registry, from 2021, recorded 17,832 new prostate cancer cases. In the past 2 years, there has been a significant increase in the number of multidisciplinary oncology consultations for prostate cancer, which correlates with the rise in diagnoses. In 2023, prostate cancer accounted for the highest number of such consultations among all cancer types, with 25,580 cases (compared to 17,321 in 2021 and 21,806 in 2022).
The number of radiation therapy procedures for prostate cancer has also been increasing since 2021. The number of hospital based brachytherapy procedures rose from 2,756 in 2020 to 3,098 in 2022 and 3,392 in 2023. The number of hospital based teletherapy procedures (excluding palliative care) increased from 10,650 in 2020 to 13,807 in 2022 and 15,415 in 2023. This indicates that radical radiotherapy procedures are not being replaced by surgical treatment.
Concentration of surgical treatment
The development of robotic surgery is beginning to have a positive impact on the concentration of surgical treatment and the growth of high volume centres, which in turn enhances the quality and safety of procedures. The trend towards the establishment of such centres is already evident in prostatectomy.
In 2023, a total of 134 hospitals billed at least one prostatectomy procedure to the National Health Fund, while 5 private facilities performed surgeries without contracts with the public payer. In 2021, the total number of hospitals performing prostatectomy was 137, and in 2022, it was 136. The number of centres has therefore remained largely unchanged. Only 14 hospitals performed fewer than 5 procedures in 2023. Since 2021, the number of hospitals performing at least 100 and at least 200 prostatectomy procedures annually has been increasing. In 2023, 46 hospitals exceeded the threshold of 100 prostatectomies, including one operating solely in the private sector (Medicover Hospital in Warsaw). Among them, 16 institutions performed more than 200 procedures – using all methods. In 2021, only 22 hospitals reached at least 100 surgeries, while in 2022, this number increased to 35.
The highest number of prostatectomies using all methods (robotic, laparoscopic, and open surgery) in 2023, according to NFZ billing data, was performed by the Prof. F. Łukaszczyk Oncology Centre in Bydgoszcz, with a total of 393 procedures, including 340 robot assisted surgeries. Three private institutions specialising in urology and making intensive use of robotic systems performed almost as many procedures. The Silesian Urology Centre UROVITA carried out 391 surgeries, the European Health Centre Otwock performed 376, and the Mazovia Hospital in Warsaw completed 317 procedures. Among the hospitals that performed at least 100 prostatectomies by all methods in 2023, only 5 did not use robot assisted surgery. The total number of procedures performed by the 30 largest facilities in 2022 was 5,190, representing 52% of all prostatectomies. In 2023, the total for the 30 largest institutions increased to 6,831, accounting for 57% of all procedures.
Robotic surgery is changing the structure of NFZ spending on prostate cancer treatment
The widespread adoption of robotic surgery has contributed to an increase in NFZ expenditures for prostate cancer treatment. From 2020 to 2023, the costs of surgical procedures rose from 69.3 million PLN to 317.9 million PLN annually, representing a 4.5fold increase. During the same period, the overall costs of care for this patient group increased 2.3 times. The additional amount spent by NFZ on robotic surgery year over year (2023 vs. 2022) was 108.9 million PLN. At the same time, expenditures on radiotherapy increased by 98.3 million PLN, and spending on pharmacotherapy (including chemotherapy and drug programmes) rose by 74.9 million PLN.
Significant changes in the cost distribution among surgical treatment, radiotherapy, and pharmacotherapy have occurred in the past two years. In 2022, the share of radical treatment costs increased from 11% to 15%, and in 2023, it further rose to 21% of NFZ expenditures for prostate cancer treatment. At the same time, the share of pharmacotherapy costs significantly declined from 36% to 27% of public spending, despite the reimbursement of several new drugs.
The article is a summary of selected excerpts from the report “Robotic Surgery 2024” published by the Modern Healthcare Institute. The analyses are based on 2023 data. The data presented in the report come from a survey conducted in hospitals using robotic systems, information obtained from the National Health Fund, robotic system manufacturers, and surgeons performing the procedures. The full report is available (in Polish) as a pdf file on www.mzdrowie.pl.
The fifth edition of the report, covering data from 2024, is expected to be published by July, 2025.
Contact to the author: kjakubiak@mzdrowie.pl
