Open Access

ARTICLE

Robotic versus laparoscopic radical nephrectomy: comparative analysis and cost considerations

Mark R. Helmers, Mark W. Ball, Michael A. Gorin, Phillip M. Pierorazio, Mohamad E. Allaf

The James Buchanan Brady Urological Institute and Department of Urology, The Johns Hopkins University School of Medicine, Baltimore, Maryland, USA

Canadian Journal of Urology 2016, 23(5), 8435-8440.

Abstract

Introduction: Robotic-assisted laparoscopic radical nephrectomy (RRN) is an increasingly utilized alternative to laparoscopic radical nephrectomy (LRN); however, there is little data on comparative effectiveness and cost of these procedures. We analyzed perioperative outcomes and hospital charge differences among patients undergoing laparoscopic radical nephrectomy (LRN) and robotic radical nephrectomy (RRN).
Materials and methods: Our institutional renal mass registry was queried for patients who underwent either LRN or RRN from 2010 to 2014. Demographic, perioperative outcomes and hospital charge data were compared between surgical approaches.
Results: Overall, 319 minimally invasive radical nephrectomies were performed during the study period. Of these, 243 were LRN and 76 were RRN. Patient demographic and tumor characteristics were similar between groups. Among operative characteristics, operative time (136 min versus 139 min, p = 0.531), intraoperative complications (2.8% versus 2.0%, p = 0.650), and length of stay (2 days versus 2 days, p = 0.745) were similar for LRN and RRN, respectively. Estimated blood loss (50 mL versus 100 mL, p = 0.041) and rate of conversion to an alternative surgical approach (1.0% versus 11.1%, p < 0.001) were higher in RRN. RRN cases were also more likely to include lymph node dissection (12.6% versus 24.2%, p = 0.031). Total charges trended higher for RRN but did not meet traditional levels of significance ($14,913 versus $16,265, p = 0.171).
Conclusions: RRN appears to be a clinically equivalent alternative to LRN with similar perioperative outcomes, albeit at greater hospital charges.

---

Keywords

---