title: Robotic versus laparoscopic radical nephrectomy: comparative analysis and cost considerations.
abstract: BACKGROUND
  Robotic-assisted laparoscopic radical nephrectomy (RRN) is an increasing utilized alternative to laparoscopic radical nephrectomy (LRN); however, there is a little data on comparative effectiveness and cost of these procedures. We analyzed perioperative outcomes and hospital charge difference among patients undergoing laparoscopic radical nephrectomy (LRN) and robotic radical nephrectomy (RRN).
  
  
  METHODS
  Our institutional renal mass registry was queried for patients who underwent either LRN or RRN from 2010 to 2014. Demographic, perioperative outcomes and hospital charge data were compared between surgical approaches.
  
  
  RESULTS
  Overall, 319 minimally invasive radical nephrectomies were performed during the study period. Of these, 243 were LRN and 76 were RRN. Patient demographic and tumor characteristics were similar between groups. Among operative characteristics, operative time (136 min versus 139 min, p = 0.531), intraoperative complications (2.8% versus 2.0%, p = 0.650), and length of stay (2 days versus 2 days, p = 0.745) were similar for LRN and RRN, respectively. Estimated blood loss (50 mL versus 100 mL, p = 0.041) and rate of conversion to an alternative surgical approach (1.0% versus 11.1%, p < 0.001) were higher in RRN. RRN cases were also more likely to include lymph node dissection (12.6% versus 24.2%, p = 0.031). Total charges trended higher for RRN but did not meet traditional levels of significance ($14,913 versus $16,265, p = 0.171).
  
  
  CONCLUSIONS
  RRN appears to be a clinically equivalent alternative to LRN with similar perioperative outcomes, albeit at greater hospital charges.
authors.affiliation: The James Buchanan Brady Urological Institute and Department of Urology, The Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.
authors.forename: Mark R
authors.initials: MR
authors.lastname: Helmers
authors.forename: Mark W
authors.initials: MW
authors.lastname: Ball
authors.forename: Michael A
authors.initials: MA
authors.lastname: Gorin
authors.forename: Phillip M
authors.initials: PM
authors.lastname: Pierorazio
authors.forename: Mohamad E
authors.initials: ME
authors.lastname: Allaf
mesh_terms: D000368:Aged; D057186:Comparative Effectiveness Research; D003362:Cost-Benefit Analysis; D003710:Demography; D005260:Female; D017722:Hospital Charges; D006801:Humans; D007680:Kidney Neoplasms / Q000601:surgery*; D010535:Laparoscopy / Q000009:adverse effects / Q000379:methods; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D009392:Nephrectomy / Q000009:adverse effects / Q000379:methods; D061646:Operative Time; D012042:Registries; D065287:Robotic Surgical Procedures / Q000009:adverse effects / Q000379:methods; D014481:United States