title: Robot-assisted vs. laparoscopic partial nephrectomy: utilization rates and perioperative outcomes.
abstract: OBJECTIVE
  To examine the effect of surgical approach on perioperative morbidity and mortality after partial nephrectomy.
  
  
  METHODS
  Within the Nationwide Inpatient Sample, patients who underwent RAPN or LPN between October 2008 and December 2009 were identified. Propensity-based matching was performed to adjust for potential baseline differences between the two groups. The rates of intraoperative and postoperative complications, blood transfusions, prolonged length of stay, and in-hospital mortality, stratified according to RAPN vs. LPN, were compared.
  
  
  RESULTS
  Overall, 851 (72.5%) patients underwent RAPN and 323 (27.5%) underwent LPN. For RAPN and LPN respectively, the following rates were recorded in the propensity-score matched cohort: blood transfusions, 4.5 vs. 6.8% (p = 0.223); intraoperative complications, 5.2 vs. 2.6% (p = 0.096); postoperative complications, 10.6 vs. 13.5% (p = 0.268); prolonged length of stay, 6.8 vs. 9.4% (p = 0.238); in-hospital mortality, 0.0 vs. 0.0%.
  
  
  CONCLUSIONS
  RAPN has supplanted LPN as the predominant minimally invasive surgical approach for renal masses. Perioperative outcomes after RAPN and LPN are comparable. Interpretation of these findings needs to take into account the lack of adjustment for case complexity and surgical expertise.
authors.affiliation: Vattikuti Urology Institute, Henry Ford Health System, Detroit, MI 48202, USA. jsammon79@gmail.com
authors.forename: Jesse D
authors.initials: JD
authors.lastname: Sammon
authors.forename: Pierre I
authors.initials: PI
authors.lastname: Karakiewicz
authors.forename: Maxine
authors.initials: M
authors.lastname: Sun
authors.forename: Praful
authors.initials: P
authors.lastname: Ravi
authors.forename: Khurshid R
authors.initials: KR
authors.lastname: Ghani
authors.forename: Wooju
authors.initials: W
authors.lastname: Jeong
authors.forename: Marco
authors.initials: M
authors.lastname: Bianchi
authors.forename: Jens
authors.initials: J
authors.lastname: Hansen
authors.forename: Paul
authors.initials: P
authors.lastname: Perrotte
authors.forename: James O
authors.initials: JO
authors.lastname: Peabody
authors.forename: Craig G
authors.initials: CG
authors.lastname: Rogers
authors.forename: Shahrokh F
authors.initials: SF
authors.lastname: Shariat
authors.forename: Mani
authors.initials: M
authors.lastname: Menon
authors.forename: Quoc-Dien
authors.initials: QD
authors.lastname: Trinh
mesh_terms: D005260:Female; D017052:Hospital Mortality; D006801:Humans; D007431:Intraoperative Complications / Q000401:mortality; D007680:Kidney Neoplasms / Q000401:mortality / Q000601:surgery*; D010535:Laparoscopy / Q000379:methods* / Q000401:mortality; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D009392:Nephrectomy / Q000379:methods* / Q000401:mortality; D059035:Perioperative Period; D011183:Postoperative Complications / Q000401:mortality; D012371:Robotics / Q000379:methods*; D025321:Surgery, Computer-Assisted / Q000379:methods* / Q000401:mortality; D016896:Treatment Outcome