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Matched comparison of robotic vs laparoscopic nephroureterectomy: an initial experience.

Abstract：

OBJECTIVE:To compare our initial robotic-assisted nephroureterectomy (RAN) experience with a well-established practice of performing laparoscopic nephroureterectomy (LN) to treat upper tract urothelial carcinoma (UTUC). METHODS:We reviewed our prospectively maintained minimally invasive surgery database. Patients who underwent RAN from April 2009 to December 2011 were matched by pathologic tumor stage and age (± 10 years) to those who underwent LN. RESULTS:Twenty-two matched pairs were evaluated. Mean operative time (298 vs 251 minutes) and estimated blood loss (EBL, 380 vs 233 mL) were significantly higher for RAN, with a greater need for transfusion in this group. Complication rates were similar. The RAN group trended toward more frequent lymph node dissection and greater median node count when lymph node dissection was performed (59% vs 27% [P = .07] and 5.5 vs 1.0 [P = .13]). After a median follow-up of 10 months for RAN and 15 months for LN, no significant difference was seen in the rate of bladder (36% vs 37%) or distant (32% vs 23%) recurrence, with similar median time to any recurrence (9 months vs 4 months, P = .32). CONCLUSION:RAN was associated with higher operative time and blood loss likely because of more frequent use of node dissection, robot repositioning, and technical inexperience. Lymph node dissection was more frequently performed with RAN, which reflects surgeon practice patterns. When a lymph node dissection was performed, the median node count was greater with RAN. Our initial experience with RAN suggests that this is an acceptable approach for the management of UTUC.

journal_name

Urology

journal_title

Urology

authors

Ambani SN,Weizer AZ,Wolf JS Jr,He C,Miller DC,Montgomery JS

doi

10.1016/j.urology.2013.07.079

subject

Has Abstract

pub_date

2014-02-01 00:00:00

pages

345-9

issue

2

eissn

0090-4295

issn

1527-9995

pii

S0090-4295(13)01288-0

journal_volume

83

pub_type

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