Robotic-Assisted Partial Nephrectomy for Kidney Cancer: A Health Technology Assessment

• Published in: Ontario health technology assessment series 2023, Vol.23 (7), p.1-77
• Main Author: Ontario Health (Quality)
• Format: Article
• Language: English
• Subjects: Humans; Kidney Neoplasms - surgery; Laparoscopy; Nephrectomy; Pain; Robotic Surgical Procedures; Systematic Reviews as Topic; Technology Assessment, Biomedical - methods
• ISSN: 1915-7398

Robotic-assisted surgery has been used in Ontario hospitals for over a decade, but there is no public funding for the robotic systems or the disposables required to perform robotic-assisted surgeries ("robotics disposables"). We conducted a health technology assessment of robotic-assisted partial nephrectomy for the treatment of kidney cancer (RAPN). Nephrectomy may be radical (the surgical removal of an entire kidney, nearby adrenal gland and lymph nodes, and other surrounding tissue) or partial (the surgical removal of part of a kidney or a kidney tumour). Partial nephrectomy is the gold standard surgical treatment for early kidney cancer. Our assessment included an evaluation of the effectiveness, safety, and cost-effectiveness of RAPN, as well as the 5-year budget impact for the Ontario Ministry of Health of publicly funding RAPN. It also looked at the experiences, preferences, and values of people with kidney cancer, as well as those of health care professionals who provide surgical treatment for kidney cancer. We performed a systematic literature search of the clinical evidence to retrieve systematic reviews and selected and reported results from five reviews that were recent and relevant to our research questions. We used the Risk of Bias in Systematic Reviews (ROBIS) tool to assess the risk of bias of each included systematic review. We assessed the quality of the body of evidence reported in the selected reviews according to the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) Working Group criteria. We performed a systematic economic literature search. We also analyzed the 5-year budget impact of publicly funding robotics disposables for RAPN for people with kidney cancer in Ontario. To contextualize the potential value of RAPN for people with kidney cancer, we spoke with people with lived experience of kidney cancer who had undergone either open or robotic-assisted nephrectomy, and we spoke with urologic surgeons who perform nephrectomy. We included five systematic reviews in the clinical evidence review. Low-quality evidence from observational studies suggests that compared with open or laparoscopic partial nephrectomy, RAPN may decrease estimated blood loss, shorten length of hospital stay, and reduce complications (All GRADEs: Low). We identified five studies that met the inclusion criteria of our economic literature review. Most included economic studies found robotic-assisted surgical procedures to be more costly