A prospective comparison of robotic and laparoscopic pyeloplasty

To determine whether robotic-assisted pyeloplasty (RLP) has any significant clinical or cost advantages over laparoscopic pyeloplasty (LP) for surgeons already facile with intracorporeal suturing. LP has become an established management approach for primary ureteropelvic junction obstruction. More r...

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Bibliographic Details
Published in:Annals of surgery 2006-04, Vol.243 (4), p.486-491
Main Authors: LINK, Richard E, BHAYANI, Sam B, KAVOUSSI, Louis R
Format: Article
Language:English
Subjects:
Biological and medical sciences
Clinical Competence
Costs and Cost Analysis
Female
General aspects
Humans
Kidney Diseases - economics
Kidney Diseases - surgery
Kidney Pelvis
Laparoscopy - economics
Male
Maryland
Medical sciences
Middle Aged
Original
Prospective Studies
Robotics - economics
Ureteral Obstruction - economics
Ureteral Obstruction - surgery
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Summary:To determine whether robotic-assisted pyeloplasty (RLP) has any significant clinical or cost advantages over laparoscopic pyeloplasty (LP) for surgeons already facile with intracorporeal suturing. LP has become an established management approach for primary ureteropelvic junction obstruction. More recently, the da Vinci robot has been applied to this procedure (RLP) in an attempt to shorten the learning curve. Whether RLP provides any significant advantage over LP for the experienced laparoscopist remains unclear. Ten consecutive cases each of transperitoneal RLP and LP performed by a single surgeon were compared prospectively with respect to surgical times and perioperative outcomes. Cost assessment was performed by sensitivity analysis using a mathematical cost model incorporating operative time, anesthesia fees, consumables, and capital equipment depreciation. The RLP and LP groups had statistically indistinguishable demographics, pathology, and similar perioperative outcomes. Mean operative and total room time for RLP was significantly longer than LP by 19.5 and 39.0 minutes, respectively. RLP was much more costly than LP (2.7 times), due to longer operative time, increased consumables costs, and depreciation of the costly da Vinci system. However, even if depreciation was eliminated, RLP was still 1.7 times as costly as LP. One-way sensitivity analysis showed that LP operative time must increase to almost 6.5 hours for it to become cost equivalent to RLP. For the experienced laparoscopist, application of the da Vinci robot resulted in no significant clinical advantage and added substantial cost to transperitoneal laparoscopic dismembered pyeloplasty.
ISSN:0003-4932
1528-1140
DOI:10.1097/01.sla.0000205626.71982.32