A prospective comparison of robotic and laparoscopic pyeloplasty.
OBJECTIVE
To determine whether robotic-assisted pyeloplasty (RLP) has any significant clinical or cost advantages over laparoscopic pyeloplasty (LP) for surgeons already facile with intracorporeal suturing.


BACKGROUND
LP has become an established management approach for primary ureteropelvic junction obstruction. More recently, the da Vinci robot has been applied to this procedure (RLP) in an attempt to shorten the learning curve. Whether RLP provides any significant advantage over LP for the experienced laparoscopist remains unclear.


METHODS
Ten consecutive cases each of transperitoneal RLP and LP performed by a single surgeon were compared prospectively with respect to surgical times and perioperative outcomes. Cost assessment was performed by sensitivity analysis using a mathematical cost model incorporating operative time, anesthesia fees, consumables, and capital equipment depreciation.


RESULTS
The RLP and LP groups had statistically indistinguishable demographics, pathology, and similar perioperative outcomes. Mean operative and total room time for RLP was significantly longer than LP by 19.5 and 39.0 minutes, respectively. RLP was much more costly than LP (2.7 times), due to longer operative time, increased consumables costs, and depreciation of the costly da Vinci system. However, even if depreciation was eliminated, RLP was still 1.7 times as costly as LP. One-way sensitivity analysis showed that LP operative time must increase to almost 6.5 hours for it to become cost equivalent to RLP.


CONCLUSIONS
For the experienced laparoscopist, application of the da Vinci robot resulted in no significant clinical advantage and added substantial cost to transperitoneal laparoscopic dismembered pyeloplasty.
James Buchanan Brady Urological Institute and Johns Hopkins Medical Institutions, Baltimore, MD, USA. rlink@www.urol.bcm.tmc.edu
Richard E
RE
Link
Sam B
SB
Bhayani
Louis R
LR
Kavoussi
D002983:Clinical Competence; D003365:Costs and Cost Analysis; D005260:Female; D006801:Humans; D007674:Kidney Diseases / Q000191:economics / Q000601:surgery*; D007682:Kidney Pelvis; D010535:Laparoscopy / Q000191:economics; D008297:Male; D008396:Maryland; D008875:Middle Aged; D011446:Prospective Studies; D012371:Robotics / Q000191:economics; D014517:Ureteral Obstruction / Q000191:economics / Q000601:surgery*