Retroperitoneal versus transperitoneal robotic-assisted laparoscopic partial nephrectomy
- 1 March 2018
- journal article
- review article
- Published by Ovid Technologies (Wolters Kluwer Health) in Current Opinion in Urology
- Vol. 28 (2), 108-114
- https://doi.org/10.1097/mou.0000000000000483
Abstract
Purpose of review To perform a bicenter, retrospective study of perioperative outcomes of retroperitoneal versus transperitoneal robotic-assisted laparoscopic partial nephrectomy (RALPN) and assess costs using time driven activity-based costing (TDABC). We identified 355 consecutive patients who underwent RALPN at University of California Los Angeles and the University of Michigan during 2009-2016. We matched according to RENAL nephrometry score, date, and institution for 78 retroperitoneal versus 78 transperitoneal RALPN. Unadjusted analyses were performed using McNemar's Chi-squared or paired t test, and adjusted analyses were performed using multivariable repeated measures regression analysis. From multivariable models, predicted probabilities were derived according to approach. Cost analysis was performed using TDABC. Recent findings Patients treated with retroperitoneal versus transperitoneal RALPN were similar in age (P=0.490), sex (P=0.715), BMI (P=0.273), and comorbidity (P=0.393). Most tumors were posterior or lateral in both the retroperitoneal (92.3%) and transperitoneal (85.9%) groups. Retroperitoneal RALPN was associated with shorter operative times (167.0 versus 191.1 min, P=0.001) and length of stay (LOS) (1.8 versus 2.7 days, P < 0.001(. There were no differences in renal function preservation or cancer control. In adjusted analyses, retroperitoneal RALPN was 17.6-min shorter (P < 0.001) and had a 76% lower probability of LOS at least 2 days (P < 0.001). Utilizing TDABC, transperitoneal RALPN added $2337 in cost when factoring in disposable equipment, operative time, LOS, and personnel. Summary In two high-volume, tertiary centers, retroperitoneal RALPN is associated with reduced operative times and shortened LOS in posterior and lateral tumors, whereas sharing similar clinicopathologic outcomes, which may translate into lower healthcare costs. Further investigation into anterior tumors is needed.Keywords
This publication has 28 references indexed in Scilit:
- The Effect of the Diffusion of the Surgical Robot on the Hospital-level Utilization of Partial NephrectomyMedical Care, 2015
- Practice Patterns and Outcomes of Open and Minimally Invasive Partial Nephrectomy Since the Introduction of Robotic Partial Nephrectomy: Results from the Nationwide Inpatient SampleJournal of Urology, 2013
- Use, Costs and Comparative Effectiveness of Robotic Assisted, Laparoscopic and Open Urological SurgeryJournal of Urology, 2012
- Contemporary Trends in Nephrectomy for Renal Cell Carcinoma in the United States: Results From a Population Based CohortJournal of Urology, 2011
- Robot-Assisted Retroperitoneal Partial Nephrectomy: Technique and Perioperative ResultsJournal of Endourology, 2011
- Impact of the Learning Curve on Perioperative Outcomes in Patients Who Underwent Robotic Partial Nephrectomy for Parenchymal Renal TumoursEuropean Urology, 2010
- Percutaneous and Laparoscopic Cryoablation of Small Renal MassesJournal of Urology, 2008
- VENA CAVAL TRANSECTION DURING RETROPERITONEOSCOPIC NEPHRECTOMY: REPORT OF THE COMPLICATION AND REVIEW OF THE LITERATUREJournal of Urology, 2004
- Solid Renal Tumors: An Analysis of Pathological Features Related to Tumor SizeJournal of Urology, 2003
- Laparoscopic Radical Nephrectomy: Incorporating Advantages of Hand Assisted and Standard LaparoscopyJournal of Urology, 2003