title: Comparison of perioperative outcomes between robotic and laparoscopic partial nephrectomy: a systematic review and meta-analysis.
abstract: BACKGROUND
  Robotic partial nephrectomy (RPN) is rapidly increasing; however, the benefit of RPN over laparoscopic partial nephrectomy (LPN) is controversial.
  
  
  OBJECTIVE
  To compare perioperative outcomes of RPN and LPN.
  
  
  METHODS
  We searched Ovid-Medline, Ovid-Embase, the Cochrane Library, KoreaMed, KMbase, KISS, RISS, and KisTi from their inception through August 2013. Two independent reviewers extracted data using a standardized form. Quality of the selected studies was assessed using the methodological index for nonrandomized studies.
  
  
  RESULTS
  A total of 23 studies and 2240 patients were included. All studies were cohort studies with no randomization, and the methodological quality varied. There was no significant difference between the two groups regarding complications of Clavien-Dindo classification grades 1-2 (p=0.62), Clavien-Dindo classification grades 3-5 (p=0.78), change of serum creatinine (p=0.65), operative time (p=0.35), estimated blood loss (p=0.76), and positive margins (p=0.75). The RPN group had a significantly lower rate of conversion to open surgery (p=0.02) and conversion to radical surgery (p=0.0006), shorter warm ischemia time (WIT; p=0.005), smaller change of estimated glomerular filtration rate (eGFR; p=0.03), and shorter length of stay (LOS; p=0.004).
  
  
  CONCLUSIONS
  This meta-analysis shows that RPN is associated with more favorable results than LPN in conversion rate to open or radical surgery, WIT, change of eGFR, and shorter LOS. To establish the safety and effectiveness outcomes of robotic surgery, well-designed randomized clinical studies with long-term follow-up are needed.
  
  
  RESULTS
  Robotic partial nephrectomy (PN) is more favorable than laparoscopic PN in terms of lower conversion rate to radical nephrectomy, a favorable renal function indexed estimated glomerular filtration rate, shorter length of hospital stay, and shorter warm ischemia time.
authors.affiliation: Division for Healthcare Technology Assessment Research, National Evidence-based Healthcare Collaborating Agency, Seoul, Korea.
authors.forename: Ji Eun
authors.initials: JE
authors.lastname: Choi
authors.affiliation: Division for Healthcare Technology Assessment Research, National Evidence-based Healthcare Collaborating Agency, Seoul, Korea.
authors.forename: Ji Hye
authors.initials: JH
authors.lastname: You
authors.affiliation: Department of Urology, Urological Science Institute, Yonsei University College of Medicine, Seoul, Korea.
authors.forename: Dae Keun
authors.initials: DK
authors.lastname: Kim
authors.affiliation: Department of Urology, Urological Science Institute, Yonsei University College of Medicine, Seoul, Korea. Electronic address: khrha@yuhs.ac.
authors.forename: Koon Ho
authors.initials: KH
authors.lastname: Rha
authors.affiliation: Department of Nursing Science, College of Nursing, Gachon University, Incheon, Korea. Electronic address: sunarea87@gachon.ac.kr.
authors.forename: Seon Heui
authors.initials: SH
authors.lastname: Lee
mesh_terms: D061887:Conversion to Open Surgery / Q000379:methods / Q000706:statistics & numerical data; D005919:Glomerular Filtration Rate; D006801:Humans; D010535:Laparoscopy / Q000379:methods*; D007902:Length of Stay / Q000706:statistics & numerical data; D009392:Nephrectomy / Q000379:methods*; D061646:Operative Time; D065287:Robotic Surgical Procedures / Q000379:methods*; D012371:Robotics / Q000295:instrumentation*; D016896:Treatment Outcome; D052096:Warm Ischemia / Q000706:statistics & numerical data
keywords: Kidney neoplasms; Laparoscopy; Nephrectomy; Robotics