title: Matched comparison of robotic vs laparoscopic nephroureterectomy: an initial experience.
abstract: OBJECTIVE
  To compare our initial robotic-assisted nephroureterectomy (RAN) experience with a well-established practice of performing laparoscopic nephroureterectomy (LN) to treat upper tract urothelial carcinoma (UTUC).
  
  
  METHODS
  We reviewed our prospectively maintained minimally invasive surgery database. Patients who underwent RAN from April 2009 to December 2011 were matched by pathologic tumor stage and age (± 10 years) to those who underwent LN.
  
  
  RESULTS
  Twenty-two matched pairs were evaluated. Mean operative time (298 vs 251 minutes) and estimated blood loss (EBL, 380 vs 233 mL) were significantly higher for RAN, with a greater need for transfusion in this group. Complication rates were similar. The RAN group trended toward more frequent lymph node dissection and greater median node count when lymph node dissection was performed (59% vs 27% [P = .07] and 5.5 vs 1.0 [P = .13]). After a median follow-up of 10 months for RAN and 15 months for LN, no significant difference was seen in the rate of bladder (36% vs 37%) or distant (32% vs 23%) recurrence, with similar median time to any recurrence (9 months vs 4 months, P = .32).
  
  
  CONCLUSIONS
  RAN was associated with higher operative time and blood loss likely because of more frequent use of node dissection, robot repositioning, and technical inexperience. Lymph node dissection was more frequently performed with RAN, which reflects surgeon practice patterns. When a lymph node dissection was performed, the median node count was greater with RAN. Our initial experience with RAN suggests that this is an acceptable approach for the management of UTUC.
authors: Department of Urology, University of Michigan Health System, Ann Arbor, MI. Electronic address: sapan@med.umich.edu.
authors: Sapan N
authors: SN
authors: Ambani
authors: Department of Urology, University of Michigan Health System, Ann Arbor, MI.
authors: Alon Z
authors: AZ
authors: Weizer
authors: Department of Urology, University of Michigan Health System, Ann Arbor, MI.
authors: J Stuart
authors: JS
authors: Wolf
authors: Department of Urology, University of Michigan Health System, Ann Arbor, MI.
authors: Chang
authors: C
authors: He
authors: Department of Urology, University of Michigan Health System, Ann Arbor, MI.
authors: David C
authors: DC
authors: Miller
authors: Department of Urology, University of Michigan Health System, Ann Arbor, MI.
authors: Jeffrey S
authors: JS
authors: Montgomery
mesh_terms: D000368:Aged; D002295:Carcinoma, Transitional Cell / Q000601:surgery*; D005260:Female; D006801:Humans; D007680:Kidney Neoplasms / Q000601:surgery*; D010535:Laparoscopy; D008297:Male; D016555:Matched-Pair Analysis; D009392:Nephrectomy / Q000379:methods*; D012189:Retrospective Studies; D012371:Robotics; D014513:Ureter / Q000601:surgery*; D014516:Ureteral Neoplasms / Q000601:surgery*