Department of Urology, Indiana University School of Medicine, Indianapolis, Indiana.
Department of Urology, Indiana University School of Medicine, Indianapolis, Indiana.
J Urol. 2014 Sep;192(3):671-6. doi: 10.1016/j.juro.2014.04.018. Epub 2014 Apr 18.
While robotic assisted radical nephrectomy is safe with outcomes and complication rates comparable to those of the pure laparoscopic approach, there is little evidence of an economic or clinical benefit.
From the 2009 to 2011 Nationwide Inpatient Sample database we identified patients 18 years old or older who underwent radical nephrectomy for primary renal malignancy. Robotic assisted and laparoscopic techniques were noted. Patients treated with the open technique and those with evidence of metastatic disease were excluded from analysis. Descriptive statistics were performed using the chi-square and Mann-Whitney tests, and the Student t-test. Multiple linear regression was done to examine factors associated with increased hospital costs and charges.
We identified 24,312 radical nephrectomy cases for study inclusion, of which 7,787 (32%) were performed robotically. There was no demographic difference between robotic assisted and pure laparoscopic radical nephrectomy cases. Median total charges were $47,036 vs $38,068 for robotic assisted vs laparoscopic surgery (p <0.001). Median total hospital costs for robotic assisted surgery were $15,149 compared to $11,735 for laparoscopic surgery (p <0.001). There was no difference in perioperative complications or the incidence of death. Compared to the laparoscopic approach robotic assistance conferred an estimated $4,565 and $11,267 increase in hospital costs and charges, respectively, when adjusted for adapted Charlson comorbidity index score, perioperative complications and length of stay (p <0.001).
Robotic assisted radical nephrectomy results in increased medical expense without improving patient morbidity. Assuming surgeon proficiency with pure laparoscopy, robotic technology should be reserved primarily for complex surgeries requiring reconstruction. Traditional laparoscopic techniques should continue to be used for routine radical nephrectomy.
虽然机器人辅助根治性肾切除术与纯腹腔镜手术相比具有安全性和相似的并发症发生率，但几乎没有证据表明其具有经济或临床优势。
我们从 2009 年至 2011 年全国住院患者数据库中确定了 18 岁或以上接受根治性肾切除术治疗原发性肾恶性肿瘤的患者。记录了机器人辅助和腹腔镜技术的使用情况。排除了采用开放技术和有转移病灶证据的患者。使用卡方检验和曼-惠特尼检验以及学生 t 检验进行描述性统计分析。进行多元线性回归分析，以检查与增加医院费用和收费相关的因素。
我们确定了 24312 例根治性肾切除术病例纳入研究，其中 7787 例（32%）采用机器人辅助技术完成。机器人辅助与纯腹腔镜根治性肾切除术患者在人口统计学方面无差异。机器人辅助组总费用中位数为 47036 美元，腹腔镜组为 38068 美元（p <0.001）。机器人辅助手术的总医院费用中位数为 15149 美元，腹腔镜手术为 11735 美元（p <0.001）。两组的围手术期并发症发生率或死亡率无差异。与腹腔镜方法相比，调整适应 Charlson 合并症指数评分、围手术期并发症和住院时间后，机器人辅助方法分别使医院费用和收费增加了 4565 美元和 11267 美元（p <0.001）。
机器人辅助根治性肾切除术增加了医疗费用，而没有改善患者的发病率。假设外科医生精通纯腹腔镜技术，机器人技术主要应保留用于需要重建的复杂手术。传统的腹腔镜技术应继续用于常规根治性肾切除术。
