Division of Urology, The Warren Alpert Medical School of Brown University, Providence, Rhode Island 02905, USA.
J Endourol. 2013 Feb;27(2):182-8. doi: 10.1089/end.2012.0210. Epub 2012 Nov 7.
Robot-assisted laparoscopic partial nephrectomy (RALPN) and laparoscopic partial nephrectomy (LPN) have become standard for the surgical management of small renal masses (SRMs). However, no studies have evaluated the short-term outcomes or cost of RALPN as compared with hand-assisted laparoscopic partial nephrectomy (HALPN) in a standardized fashion.
A retrospective review of all patients who underwent HALPN or RALPN from 2006 to 2010 were assessed for patient age, body mass index (BMI), American Society of Anesthesiologists (ASA) score, radiographic tumor size, nephrometry (radius, endo/exophytic, nearness to collecting system, anterior/posterior, lines of polarity [RENAL]) scores, operative and room times, hospital length of stay (LOS), estimated blood loss (EBL), requirement of hilar vessel clamping, warm ischemia time (WIT), pre- and postprocedural creatinine and hemoglobin levels, and complications. Total costs of the procedures were estimated based on operating room component (operative staff time, anesthesia, and supply) and hospital stay cost (room and board, pharmacy). A robotic premium cost, estimated based on the yearly overall cost of the da Vinci S surgical system divided by the annual number of cases, was included in the RALPN cost. Cost figures were obtained from hospital administration and applied to the mean HALPN and RALPN patient.
Forty-seven patients underwent HALPN since 2006 and 21 patients underwent RALPN since 2008. ASA, BMI, EBL, tumor size, nephrometry score, positive margin rate, change in creatinine, change in hemoglobin, morphine equivalents used, and complication rate were all similar in both groups (p>0.05). Room time and operative time were significantly shorter for the HALPN cohort (p=0.001) whereas LOS was significantly shorter in the RALPN cohort (p=0.019). Despite the shorter LOS, RALPN was associated with a $1165 increased cost, mainly due to increased operating room time and premium cost of the robot.
While early in our experience, RALPN offered no significant advantage in short-term outcomes over HALPN and was associated with an increased cost of over $1150.
机器人辅助腹腔镜肾部分切除术（RALPN）和腹腔镜肾部分切除术（LPN）已成为治疗小肾肿瘤（SRM）的标准手术方法。然而，尚无研究以标准化方式评估 RALPN 与手助腹腔镜肾部分切除术（HALPN）相比的短期结果或成本。
回顾性分析了 2006 年至 2010 年间接受 HALPN 或 RALPN 的所有患者，评估患者年龄、体重指数（BMI）、美国麻醉医师协会（ASA）评分、影像学肿瘤大小、肾肿瘤测量（半径、内/外生、靠近集合系统、前后、极性线[RENAL]）评分、手术和房间时间、住院时间（LOS）、估计失血量（EBL）、肾血管夹闭的需求、热缺血时间（WIT）、术前和术后肌酐和血红蛋白水平以及并发症。根据手术室组成部分（手术人员时间、麻醉和供应）和住院费用（房间和伙食费、药房）估算手术总成本。RALPN 成本中包括根据达芬奇 S 手术系统每年总成本除以每年手术例数估算出的机器人溢价成本。成本数据来自医院管理部门，并应用于平均 HALPN 和 RALPN 患者。
2006 年以来，47 例患者接受 HALPN，2008 年以来，21 例患者接受 RALPN。两组患者的 ASA、BMI、EBL、肿瘤大小、肾肿瘤测量评分、阳性切缘率、肌酐变化、血红蛋白变化、吗啡等效物使用量和并发症发生率均无显著差异（p>0.05）。HALPN 组的房间时间和手术时间明显短于 RALPN 组（p=0.001），而 RALPN 组的 LOS 明显短于 HALPN 组（p=0.019）。尽管 LOS 较短，但 RALPN 与增加 1165 美元的成本相关，这主要是由于手术室时间和机器人溢价成本增加所致。
尽管在我们的经验中还处于早期阶段，但 RALPN 在短期结果方面并未明显优于 HALPN，且成本增加超过 1150 美元。
