Minimally invasive partial nephrectomy in the era of robotic surgery

Abstract

Objectives: The objectives of the study were to compare the operative features, complication rates, functional, and pathological outcomes of laparoscopic partial nephrectomy (LPN) and robotic-assisted partial nephrectomy (RPN). Methods: The demographics, perioperative, and follow-up data of patients who underwent partial nephrectomy between January 2007 and April 2020 with minimally invasive methods were retrospectively analyzed. Patients with minimum 3 months follow-up were enrolled in the present study. Perioperative and pathological outcomes were compared between the patients underwent LPN and RPN. Results: A total of 85 patients (65 LPN and 20 RPN) were included in the present study. The mean patient age at the time of surgery was 56.31±10.48 years. Female-to-male ratio was 30/55. Patients in the RPN group had higher R.E.N.A.L. and PADUA scores (p=0.039 and p=0.030, respectively). Median warm ischemia time, median operation time, median intraoperative estimated blood loss, mean post-operative hemoglobin change, and median hospitalization time were similar between groups (p=0.133, p=0.753, p=0.079, p=0.882, and p=0.473, respectively). Artery-only clamping rate was significantly higher in RPN group (p=0.033). The cost of RPN was significantly greater than LPN (p<0.001). Transfusion rates, post-operative complication rates, percent of estimated glomerular filtration rate change at the last follow-up, and trifecta achievement were similar between the groups (p=0.622, p=0.238, p=0.428, and p=0.349, respectively). Conclusion: In this series, similar perioperative and functional outcomes were achieved by RPN compared to LPN in more complex renal masses.

One-year healthcare costs after robotic-assisted and laparoscopic partial and radical nephrectomy: a cohort study

“…Literature comparing index expenditure for partial nephrectomy between robotic and laparoscopic approaches is not as robust. Using single-center Turkish data, Haberal et al found that the robotic approach resulted in a significantly higher procedure cost than laparoscopic approach ($17,626 vs. $4,542, p < 0.001) [ 8 ]. Another single-center study in China also reported higher total hospital cost with robotic partial nephrectomy as compared to laparoscopic partial nephrectomy [ 13 ].…”

“…Previous studies comparing the cost of robotic surgery to laparoscopic surgery have focused on the cost of the index surgery and the period immediately after surgery and, generally, have reported a higher cost for robotic surgery [ 6 – 8 , 12 – 14 ]. This may be due to the high cost of acquisition and maintenance of robotic technology, which is reflected in the immediate perioperative cost of the surgery.…”