title: Robotic versus open partial nephrectomy: a systematic review and meta-analysis.
abstract: OBJECTIVE
  To critically review the currently available evidence of studies comparing robotic partial nephrectomy (RPN) and open partial nephrectomy (OPN).
  
  
  METHODS
  A comprehensive review of the literature from Pubmed, Web of Science and Scopus was performed in October 2013. All relevant studies comparing RPN with OPN were included for further screening. A cumulative meta-analysis of all comparative studies was performed and publication bias was assessed by a funnel plot.
  
  
  RESULTS
  Eight studies were included for the analysis, including a total of 3418 patients (757 patients in the robotic group and 2661 patients in the open group). Although RPN procedures had a longer operative time (weighted mean difference [WMD]: 40.89; 95% confidence interval [CI], 14.39-67.40; p = 0.002), patients in this group benefited from a lower perioperative complication rate (19.3% for RPN and 29.5% for OPN; odds ratio [OR]: 0.53; 95%CI, 0.42-0.67; p<0.00001), shorter hospital stay (WMD: -2.78; 95%CI, -3.36 to -1.92; p<0.00001), less estimated blood loss(WMD: -106.83; 95%CI, -176.4 to -37.27; p = 0.003). Transfusions, conversion to radical nephrectomy, ischemia time and estimated GFR change, margin status, and overall cost were comparable between the two techniques. The main limitation of the present meta-analysis is the non-randomization of all included studies.
  
  
  CONCLUSIONS
  RPN appears to be an efficient alternative to OPN with the advantages of a lower rate of perioperative complications, shorter length of hospital stay and less blood loss. Nevertheless, high quality prospective randomized studies with longer follow-up period are needed to confirm these findings.
authors.affiliation: Department of Urology, Changhai Hospital, Second Military Medical University, Shanghai, P. R. China.
authors.forename: Zhenjie
authors.initials: Z
authors.lastname: Wu
authors.affiliation: Department of Radiology, Changhai Hospital, Second Military Medical University, Shanghai, P. R. China.
authors.forename: Mingmin
authors.initials: M
authors.lastname: Li
authors.affiliation: Department of Urology, Changhai Hospital, Second Military Medical University, Shanghai, P. R. China.
authors.forename: Bing
authors.initials: B
authors.lastname: Liu
authors.affiliation: Department of Special Clinic, Changhai Hospital, Second Military Medical University, Shanghai, P. R. China.
authors.forename: Chen
authors.initials: C
authors.lastname: Cai
authors.affiliation: Department of Urology, Changhai Hospital, Second Military Medical University, Shanghai, P. R. China.
authors.forename: Huamao
authors.initials: H
authors.lastname: Ye
authors.affiliation: Department of Urology, Changhai Hospital, Second Military Medical University, Shanghai, P. R. China.
authors.forename: Chen
authors.initials: C
authors.lastname: Lv
authors.affiliation: Department of Urology, Changhai Hospital, Second Military Medical University, Shanghai, P. R. China.
authors.forename: Qing
authors.initials: Q
authors.lastname: Yang
authors.affiliation: Department of Radiology, Changhai Hospital, Second Military Medical University, Shanghai, P. R. China.
authors.forename: Jing
authors.initials: J
authors.lastname: Sheng
authors.affiliation: Department of Urology, Changhai Hospital, Second Military Medical University, Shanghai, P. R. China.
authors.forename: Shangqing
authors.initials: S
authors.lastname: Song
authors.affiliation: Department of Urology, Changhai Hospital, Second Military Medical University, Shanghai, P. R. China.
authors.forename: Le
authors.initials: L
authors.lastname: Qu
authors.affiliation: Department of Urology, Changhai Hospital, Second Military Medical University, Shanghai, P. R. China.
authors.forename: Liang
authors.initials: L
authors.lastname: Xiao
authors.affiliation: Department of Urology, Changhai Hospital, Second Military Medical University, Shanghai, P. R. China.
authors.forename: Yinghao
authors.initials: Y
authors.lastname: Sun
authors.affiliation: Department of Urology, Changhai Hospital, Second Military Medical University, Shanghai, P. R. China.
authors.forename: Linhui
authors.initials: L
authors.lastname: Wang
mesh_terms: D016063:Blood Loss, Surgical; D003362:Cost-Benefit Analysis; D006801:Humans; D007902:Length of Stay; D009392:Nephrectomy / Q000191:economics / Q000379:methods*; D061646:Operative Time; D012371:Robotics / Q000191:economics / Q000379:methods*; D016896:Treatment Outcome
references.citation: J Endourol. 2010 Jan;24(1):57-61
references.pmid: 19958156
references.citation: J Endourol. 1993 Dec;7(6):521-6
references.pmid: 8124349
references.citation: Control Clin Trials. 1996 Feb;17(1):1-12
references.pmid: 8721797
references.citation: Eur Urol. 2012 Mar;61(3):593-9
references.pmid: 22154728
references.citation: J Urol. 2012 Apr;187(4):1392-8
references.pmid: 22341274
references.citation: World J Urol. 2014 Feb;32(1):287-93
references.pmid: 23913095
references.citation: BMC Med Res Methodol. 2005 Apr 20;5:13
references.pmid: 15840177
references.citation: World J Urol. 2010 Feb;28(1):111-5
references.pmid: 19499225
references.citation: J Endourol. 2011 Jul;25(7):1181-5
references.pmid: 21657825
references.citation: JAMA. 2012 Apr 18;307(15):1629-35
references.pmid: 22511691
references.citation: Ann Surg. 2004 Aug;240(2):205-13
references.pmid: 15273542
references.citation: J Endourol. 2013 May;27(5):560-5
references.pmid: 23130756
references.citation: Urol Oncol. 2013 Aug;31(6):924-9
references.pmid: 21906969
references.citation: Lancet. 1998 Aug 22;352(9128):609-13
references.pmid: 9746022
references.citation: J Urol. 2010 Feb;183(2):467-72
references.pmid: 20006875
references.citation: J Natl Cancer Inst. 1959 Apr;22(4):719-48
references.pmid: 13655060
references.citation: Control Clin Trials. 1986 Sep;7(3):177-88
references.pmid: 3802833
references.citation: Arch Ital Urol Androl. 2002 Jun;74(2):65-8
references.pmid: 12161939
references.citation: Eur Urol. 2012 Oct;62(4):696-703
references.pmid: 22483407
references.citation: Eur Urol. 2012 Oct;62(4):601-12
references.pmid: 22704730
references.citation: Urology. 2013 Mar;81(3):533-8
references.pmid: 23295137
references.citation: J Urol. 2012 Jun;187(6):2000-4
references.pmid: 22498208
references.citation: Ann Intern Med. 2001 Dec 4;135(11):982-9
references.pmid: 11730399
references.citation: Eur Urol. 2012 Sep;62(3):553-61
references.pmid: 22658759
references.citation: Eur Urol. 2012 May;61(5):972-93
references.pmid: 22405593
references.citation: Eur Urol. 2012 Dec;62(6):1023-33
references.pmid: 22771266
references.citation: Eur Urol. 2011 Mar;59(3):325-30
references.pmid: 21144643
references.citation: Urology. 2004 Nov;64(5):914-8
references.pmid: 15533477
references.citation: JSLS. 2012 Oct-Dec;16(4):581-7
references.pmid: 23484568
references.citation: BMJ. 2003 Sep 6;327(7414):557-60
references.pmid: 12958120