Robotic-Assisted Radical Nephrectomy: No Difference in Outcomes But Takes Longer and Costs More Interview with:
In Gab Jeong, MD

Associate Professor
Department of Urology, Asan Medical Center
University of Ulsan College of Medicine
Seoul, Korea What is the background for this study? What are the main findings?

Response: Use of robotic surgery has increased in urological practice over the last decade especially for the surgery that was difficult to perform with laparoscopic techniques such as radical prostatectomy for prostate cancer or partial resection of kidney cancer. However, the use, outcomes, and costs of robotic nephrectomy are unknown.

We examined the trend in use of robotic-assisted operations for radical nephrectomy in the United States and compared the perioperative outcomes and costs with laparoscopic radical nephrectomy. The proportion of radical nephrectomies using robotic-assisted operations increased from 1.5% in 2003 to 27.0% in 2015. Although there was no significant difference between robotic-assisted vs laparoscopic radical nephrectomy in major postoperative complications, robotic-assisted procedures were associated with longer operating time and higher direct hospital costs. The rate of prolonged operating time (>4 hours) for patients undergoing the robotic-assisted procedure was higher than for patients receiving the laparoscopic procedure (46.3% vs 25.8%; risk difference, 20.5%; 95% CI, 14.2% to 26.8%). Robotic-assisted radical nephrectomy was associated with higher mean 90-day direct hospital costs ($19530 vs $16851; difference, $2678; 95% CI, $838 to $4519). What should readers take away from your report?

Response: The development and use of robotic platform might be helpful in patient care. However, scientific research on cost-effectiveness and safety has sometimes not been sufficiently conducted, and it is rapidly spreading in the medical field due to various reasons such as marketing of the company, patient’s preference for the latest technology, and recommendations of the hospital/doctors. For the patient, when choosing to receive robotic surgery, it is necessary to have enough consultation with the doctor and understand their advantages and disadvantages compared with the existing conventional laparoscopic surgery. What recommendations do you have for future research as a result of this study?

Response: The rapid increase in costly robot surgery in lieu of laparoscopic surgery without a definite advantage for the patient is a problem that can be applied not only to the urological field but also to the entire surgical field. This may lead to a huge increase in the cost of medical care that can be a significant burden on the healthcare system, and thus requires constant monitoring. 

Disclosures: One of coauthor reported personal fees from Intuitive Surgical. No other disclosures were reported. Thank you for your contribution to the community.


Jeong IG, Khandwala YS, Kim JH, Han DH, Li S, Wang Y, Chang SL, Chung BI. Association of Robotic-Assisted vs Laparoscopic Radical Nephrectomy With Perioperative Outcomes and Health Care Costs, 2003 to 2015. JAMA. 2017;318(16):1561–1568. doi:10.1001/jama.2017.14586

Note: Content is Not intended as medical advice. Please consult your health care provider regarding your specific medical condition and questions.


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Last Updated on October 25, 2017 by Marie Benz MD FAAD