Trends in Renal Surgery: Robotic Technology is Associated with Increased Use of Partial Nephrectomy

Patel, Hiten D.; Mullins, Jeffrey K.; Pierorazio, Phillip M.; Jayram, Gautam; Cohen, Jason; Matlaga, Brian R.; Allaf, Mohamad E.

doi:10.1016/j.juro.2012.10.024

Cited by 222 publications

(120 citation statements)

References 30 publications

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“…3 In the last 10 years, robotic surgery has emerged as an alternative minimally invasive surgical treatment for many malignancies, including urological cancers. 4,[23][24][25] In prostate cancer, robotic-assisted radical prostatectomy has overtaken the traditional open approach: 64% vs. 36% as of the year 2009, respectively. 25 In kidney cancer, robotic-assisted partial nephrectomy has also generated considerable interest, given its less prohibitive learning curve compared to the laparoscopic approach.…”

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

“…This trend is comparable to the use of robotics in other malignancies. 23,24 Robotic-assisted prostatectomy represents a noteworthy example of this phenomenon, where the utilization rate between 2005 and 2008 jumped by 60%, albeit with a decreasing incidence of prostate cancer. 27 The trends observed for RANU are most likely attributed to the aggressive marketing strategies and patient expectations, despite limited level 1 evidence efficacy data supporting its comparative effectiveness relative to traditional treatment modalities.…”

Section: Cuaj • September-october 2014 • Volume 8 Issues 9-10 E698mentioning

confidence: 99%

“…25 In kidney cancer, robotic-assisted partial nephrectomy has also generated considerable interest, given its less prohibitive learning curve compared to the laparoscopic approach. 24 Similarly, RANU has gained con-CUAJ • September-October 2014 • Volume 8, Issues 9-10 E698 Trudeau et al While such studies are undoubtedly meaningful and informative, all such reports were based on a small number of patients treated at tertiary care centres, where the feasibility of the procedure may be greatly different in the community. Furthermore, given the rarity of UTUC, it is unlikely that a randomized trial comparing RANU to the standard approach or LNU will ever be conducted in upcoming years.…”

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confidence: 99%

See 3 more Smart Citations

Robot-assisted versus laparoscopic nephroureterectomy for uppertract urothelial cancer: A population-based assessment of costs and perioperative outcomes

Trudeau

Gandaglia

Shiffmann

et al. 2014

CUAJ

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Introduction: We compared short-term outcomes and costs between robotic-assisted nephroureterectomy (RANU) and laparoscopic radical nephroureterectomy (LNU) in a large populationbased cohort of patients with upper-tract urothelial carcinoma (UTUC). Methods: Overall, 1914 patients with UTUC treated with RANU or LNU between 2008 and 2010 within the Nationwide Inpatient Sample were abstracted. Propensity-score matching was performed to account for inherent differences between patients undergoing RANU and LNU. Multivariable logistic regression models were fitted to compare postoperative complications, blood transfusions, prolonged length of stay, and costs between the 2 procedures. Results: Overall, a weighted estimate of 1199 (62.6%) and 715 (37.4%) patients received LNU and RANU, respectively. In multivariable analyses no significant differences were observed in postoperative transfusion and length of stay between the 2 surgical approaches (all p > 0.1). However, patients undergoing RANU were less likely to experience any complications compared to their counterparts undergoing LNU (p = 0.04). The utilization of RANU was associated with substantially higher costs compared to the laparoscopic approach. Our study is limited by its retrospective nature and the lack of adjustment for tumour stage and grade. Conclusions: Our results support the safety and feasibility of RANU for the treatment of UTUC. Indeed, the use of the robotic approach was associated with lower probability of experiencing perioperative complications compared to LNU. On the other hand, the utilization of RANU is associated with higher costs compared to LNU. IntroductionUpper-tract urothelial carcinoma (UTUC) accounts for about 5% of all urothelial carcinomas.1 According to treatment guidelines, radical nephroureterectomy (RNU) represents the treatment of choice for localized disease.2 Based on equal efficacy and easier convalescence compared to the open procedure, many urologists have advocated minimally invasive approaches as the standard of care. 2,3 In this context, laparoscopic nephroureterectomy (LNU) and robotic-assisted nephroureterectomy (RANU) are available; the robotic approach is being increasingly adopted for several other urologic malignancies.4 That being said, there is little data evaluating the safety and feasibility of RANU.5 To date, only few retrospective studies have been published, with limited sample size (ranging from 11 to 43), originating from tertiary referral centres, where results may not be representative of the American population at large. [6][7][8][9][10][11] In the face of such little data, we wanted to examine short-term outcomes of RANU compared with LNU using a large contemporary cohort of patients representative of the United States population. Specifically, we focused on perioperative complications, blood transfusions, prolonged length of stay, in-hospital mortality and hospitalization costs. (NIS) database were abstracted. The NIS is a 20% stratified probability sample that encompasses about 8 million ...

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Cuaj • September-october 2014 • Volume 8 Issues 9-10 E698mentioning

confidence: 99%

mentioning

confidence: 99%

See 2 more Smart Citations

Robot-assisted versus laparoscopic nephroureterectomy for uppertract urothelial cancer: A population-based assessment of costs and perioperative outcomes

Trudeau

Gandaglia

Shiffmann

et al. 2014

CUAJ

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“…[3] With high definition 3-D vision system, magnification of surgical field, and EndoWrist ® instruments, RPN is being performed with a wide range of indications, including larger and high complex tumors. [4] Combining these features with intraoperative ultrasonography enables resection of the tumor with minimal amount of parenchyma during PN. Although maximizing the amount of preserved parenchyma is as important as warm ischemia time (WIT) for functional preservation, surgical margin positivity (PSM) is crucial for oncological outcomes.…”

Section: Introductionmentioning

confidence: 99%

Is robotic partial nephrectomy convenient for solitary kidney?

Kaouk

Malkoç

2016

Turkish Journal of Urology

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Nephron sparing surgery (NSS) is the gold standard treatment option for patients with a solitary kidney in order to preserve renal function. Open partial nephrectomy (OPN) has been long considered the standard care for NSS. Robotic partial nephrectomy (RPN) is being gradually used more commonly even for solitary kidney and complex tumors. There was no difference between RPN and OPN regarding the rate of intraoperative-postoperative complications and positive surgical margin (PSM) (RPN: 7.5%, OPN: 8%) for patients with solitary kidney who underwent partial nephrectomy for small renal masses. Warm ischemia time (WIT) in all of our studies was within the safe range of <25 minutes which is acceptable ischemia time for robotic approaches. More studies are needed in order to evaluate kidney function. In conclusion with increasing experience, solitary kidney tumors can be managed safely with robotic approach. For patients having complex tumors with a potential of WIT >25 minutes, administration of intracorporeal ice slush during surgery may be considered.

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Association of Robotic-Assisted vs Laparoscopic Radical Nephrectomy With Perioperative Outcomes and Health Care Costs, 2003 to 2015

Jeong

Khandwala

Kim

et al. 2017

JAMA

188

138

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Trends in Renal Surgery: Robotic Technology is Associated with Increased Use of Partial Nephrectomy

Cited by 222 publications

References 30 publications

Robot-assisted versus laparoscopic nephroureterectomy for uppertract urothelial cancer: A population-based assessment of costs and perioperative outcomes

Robot-assisted versus laparoscopic nephroureterectomy for uppertract urothelial cancer: A population-based assessment of costs and perioperative outcomes

Is robotic partial nephrectomy convenient for solitary kidney?

Association of Robotic-Assisted vs Laparoscopic Radical Nephrectomy With Perioperative Outcomes and Health Care Costs, 2003 to 2015

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