title: Robotic radical nephrectomy for renal cell carcinoma: a systematic review.
abstract: BACKGROUND
  Laparoscopic radical nephrectomy (LRN) is the actual gold-standard for the treatment of clinically localized renal cell carcinoma (RCC) (cT1-2 with no indications for nephron-sparing surgery). Limited evidence is currently available on the role of robotics in the field of radical nephrectomy. The aim of the current study was to provide a systematic review of the current evidence on the role of robotic radical nephrectomy (RRN) and to analyze the comparative studies between RRN and open nephrectomy (ON)/LRN.
  
  
  METHODS
  A Medline search was performed between 2000-2013 with the terms "robotic radical nephrectomy", "robot-assisted laparoscopic nephrectomy", "radical nephrectomy". Six RRN case-series and four comparative studies between RRN and (ON)/pure or hand-assisted LRN were identified.
  
  
  RESULTS
  Current literature produces a low level of evidence for RRN in the treatment of RCC, with only one prospective study available. Mean operative time (OT) ranges between 127.8-345 min, mean estimated blood loss (EBL) ranges between 100-273.6 ml, and mean hospital stay (HS) ranges between 1.2-4.3 days. The comparison between RRN and LRN showed no differences in the evaluated outcomes except for a longer OT for RRN as evidenced in two studies. Significantly higher direct costs and costs of the disposable instruments were also observed for RRN. The comparison between RRN and ON showed that ON is characterized by shorter OT but higher EBL, higher need of postoperative analgesics and longer HS.
  
  
  CONCLUSIONS
  No advantage of robotics over standard laparoscopy for the treatment of clinically localized RCC was evidenced. Promising preliminary results on oncologic efficacy of RRN have been published on the T3a-b disease. Fields of wider application of robotics should be researched where indications for open surgery still persist.
authors.affiliation: UOC of Urology, Department of Experimental Medicine and Surgery, University of Tor Vergata, Policlinico Casilino, Rome, Italy. tasospao2003@yahoo.com.
authors.forename: Anastasios D
authors.initials: AD
authors.lastname: Asimakopoulos
authors.forename: Roberto
authors.initials: R
authors.lastname: Miano
authors.forename: Filippo
authors.initials: F
authors.lastname: Annino
authors.forename: Salvatore
authors.initials: S
authors.lastname: Micali
authors.forename: Enrico
authors.initials: E
authors.lastname: Spera
authors.forename: Beniamino
authors.initials: B
authors.lastname: Iorio
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Vespasiani
authors.forename: Richard
authors.initials: R
authors.lastname: Gaston
mesh_terms: D016063:Blood Loss, Surgical; D002292:Carcinoma, Renal Cell / Q000601:surgery*; D017721:Hospital Costs; D006801:Humans; D007680:Kidney Neoplasms / Q000601:surgery*; D010535:Laparoscopy / Q000191:economics; D007902:Length of Stay; D009392:Nephrectomy / Q000191:economics / Q000379:methods*; D061646:Operative Time; D011183:Postoperative Complications; D012371:Robotics / Q000191:economics