Link Richard E, Bhayani Sam B, Kavoussi Louis R
James Buchanan Brady Urological Institute and Johns Hopkins Medical Institutions, Baltimore, MD, USA.
Ann Surg. 2006 Apr;243(4):486-91. doi: 10.1097/01.sla.0000205626.71982.32.
To determine whether robotic-assisted pyeloplasty (RLP) has any significant clinical or cost advantages over laparoscopic pyeloplasty (LP) for surgeons already facile with intracorporeal suturing.
LP has become an established management approach for primary ureteropelvic junction obstruction. More recently, the da Vinci robot has been applied to this procedure (RLP) in an attempt to shorten the learning curve. Whether RLP provides any significant advantage over LP for the experienced laparoscopist remains unclear.
Ten consecutive cases each of transperitoneal RLP and LP performed by a single surgeon were compared prospectively with respect to surgical times and perioperative outcomes. Cost assessment was performed by sensitivity analysis using a mathematical cost model incorporating operative time, anesthesia fees, consumables, and capital equipment depreciation.
The RLP and LP groups had statistically indistinguishable demographics, pathology, and similar perioperative outcomes. Mean operative and total room time for RLP was significantly longer than LP by 19.5 and 39.0 minutes, respectively. RLP was much more costly than LP (2.7 times), due to longer operative time, increased consumables costs, and depreciation of the costly da Vinci system. However, even if depreciation was eliminated, RLP was still 1.7 times as costly as LP. One-way sensitivity analysis showed that LP operative time must increase to almost 6.5 hours for it to become cost equivalent to RLP.
For the experienced laparoscopist, application of the da Vinci robot resulted in no significant clinical advantage and added substantial cost to transperitoneal laparoscopic dismembered pyeloplasty.
对于已经熟练掌握体内缝合技术的外科医生，确定机器人辅助肾盂成形术（RLP）相较于腹腔镜肾盂成形术（LP）是否具有任何显著的临床或成本优势。
LP已成为原发性输尿管肾盂连接部梗阻的既定治疗方法。最近，达芬奇机器人已应用于该手术（RLP），试图缩短学习曲线。对于经验丰富的腹腔镜手术医生而言，RLP是否比LP具有任何显著优势仍不明确。
前瞻性比较由同一位外科医生连续进行的10例经腹RLP和10例LP的手术时间和围手术期结果。使用包含手术时间、麻醉费用、耗材和资本设备折旧的数学成本模型进行敏感性分析以评估成本。
RLP组和LP组在人口统计学、病理学方面无统计学差异，围手术期结果相似。RLP的平均手术时间和总手术室时间分别比LP显著长19.5分钟和39.0分钟。由于手术时间更长、耗材成本增加以及昂贵的达芬奇系统折旧，RLP的成本比LP高得多（2.7倍）。然而，即使消除折旧，RLP的成本仍是LP的1.7倍。单向敏感性分析表明，LP的手术时间必须增加到近6.5小时才能在成本上与RLP相当。
对于经验丰富的腹腔镜手术医生，应用达芬奇机器人并未带来显著的临床优势，且增加了经腹腹腔镜离断性肾盂成形术的大量成本。
