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    Use of robotic RN rising, despite unclear advantages

    Surgeon comfort level, hospital efficiency among possible reasons for trend

    Orlando, FL—The use of robot-assisted radical nephrectomy increased by 6% over a recent 3-year period, and high-volume robotic centers for partial nephrectomy were found more likely to perform robotic radical nephrectomy despite its increased cost and similar complications to laparoscopic radical nephrectomy, according to a recent study.

    Commentary - Robotic radical nephrectomy: Really?

    At the AUA annual meeting in Orlando, FL, researchers reported that a growing number of centers now routinely perform robot-assisted partial nephrectomy and robot-assisted radical prostatectomy, despite debate over whether, in the case of the latter surgery, this is the right utilization of this technology and whether overutilization may be occurring. Researchers analyzed the utilization and complications of robotic, laparoscopic, and open radical nephrectomy (RN) and factors that predict its use.

    For the study, the authors mined the Nationwide Inpatient Sample to identify patients undergoing RN from the last quarter of 2008 through 2010. They identified 124,462 patients who had undergone RN (robotic, 5.7%; laparoscopic, 14.7%; open, 80.6%). They stratified population and hospital demographics by frequency of RN surgical approach. Complication rates were compared among patients undergoing open, laparoscopic, and robotic RN.

    “To our knowledge, this is the first analysis that has attempted to identify patient- and hospital-specific factors predictive of use of a specific surgical approach for performing RN. Overall, in terms of trends of utilization, we are seeing that use of the robotic surgical platform for RN has been increasing over the sampled time period. In total, there has been a 6% increase,” said study investigator Michael Rothberg, a medical student and urologic oncology research fellow at Columbia University Medical Center, New York.

    The da Vinci surgical robot (Intuitive Surgical, Inc., Sunnyvale, CA) may provide advantages in terms of complex intracorporeal reconstruction and suturing during minimally invasive surgery. However, the authors question whether this potential advantage applies to RN, and they looked at what factors may be driving the increased utilization of robotic RN.

     

    Next: Hospital factors appear to predict use of robot

     

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