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Zeuschner P, Böttcher C, Hager L, Linxweiler J, Stöckle M, Siemer S. Last Resort from Nursing Shortage? Comparative Cost Analysis of Open vs. Robot-Assisted Partial Nephrectomies with a Focus on the Costs of Nursing Care. Cancers (Basel) 2023; 15:cancers15082291. [PMID: 37190219 DOI: 10.3390/cancers15082291] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Revised: 04/12/2023] [Accepted: 04/12/2023] [Indexed: 05/17/2023] Open
Abstract
Despite perioperative advantages, robot-assisted surgery is associated with high costs. However, the lower morbidity of robotic surgery could lead to a lower nursing workload and cost savings. In this comparative cost analysis of open retroperitoneal versus robot-assisted transperitoneal partial nephrectomies (PN), these possible cost savings, including other cost factors, were quantified. Therefore, patient, tumor characteristics, and surgical results of all PN within two years at a tertiary referral center were retrospectively analyzed. The nursing effort was quantified by the local nursing staff regulation and INPULS® intensive care and performance-recording system. Out of 259 procedures, 76.4% were performed robotically. After propensity score matching, the median total nursing time (2407.8 vs. 1126.8 min, p < 0.001) and daily nursing effort (245.7 vs. 222.6 min, p = 0.025) were significantly lower after robotic surgery. This resulted in mean savings of EUR 186.48 in nursing costs per robotic case, in addition to savings of EUR 61.76 due to less frequent administrations of erythrocyte concentrates. These savings did not amortize the higher material costs for the robotic system, causing additional expenses of EUR 1311.98 per case. To conclude, the nursing effort after a robotic partial nephrectomy was significantly lower compared to open surgery; however, this previously unnoticed savings mechanism alone could not amortize the overall increased costs.
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Affiliation(s)
- Philip Zeuschner
- Department of Urology and Pediatric Urology, Saarland University, 66123 Homburg, Saarland, Germany
| | - Carolin Böttcher
- Department of Urology and Pediatric Urology, Saarland University, 66123 Homburg, Saarland, Germany
| | - Lutz Hager
- SRH Distance Learning University, Kirchstraße 26, 88499 Riedlingen, Germany
| | - Johannes Linxweiler
- Department of Urology and Pediatric Urology, Saarland University, 66123 Homburg, Saarland, Germany
| | - Michael Stöckle
- Department of Urology and Pediatric Urology, Saarland University, 66123 Homburg, Saarland, Germany
| | - Stefan Siemer
- Department of Urology and Pediatric Urology, Saarland University, 66123 Homburg, Saarland, Germany
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Grobet‐Jeandin E, Pinar U, Parra J, Vaessen C, Chartier‐Kastler E, Seisen T, Rouprêt M. Medico‐economic impact of onco‐urological robot‐assisted minimally invasive surgery in a high‐volume centre. Int J Med Robot 2022; 18:e2462. [DOI: 10.1002/rcs.2462] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2022] [Revised: 09/03/2022] [Accepted: 09/11/2022] [Indexed: 11/11/2022]
Affiliation(s)
- Elisabeth Grobet‐Jeandin
- Sorbonne University GRC 5 Predictive Onco‐Urology APHP Pitié‐Salpêtrière Hôpital Urology Paris France
- Division of Urology Geneva University Hospitals Geneva Switzerland
| | - Ugo Pinar
- Sorbonne University GRC 5 Predictive Onco‐Urology APHP Pitié‐Salpêtrière Hôpital Urology Paris France
| | - Jérôme Parra
- Sorbonne University GRC 5 Predictive Onco‐Urology APHP Pitié‐Salpêtrière Hôpital Urology Paris France
| | - Christophe Vaessen
- Sorbonne University GRC 5 Predictive Onco‐Urology APHP Pitié‐Salpêtrière Hôpital Urology Paris France
| | - Emmanuel Chartier‐Kastler
- Sorbonne University GRC 5 Predictive Onco‐Urology APHP Pitié‐Salpêtrière Hôpital Urology Paris France
| | - Thomas Seisen
- Sorbonne University GRC 5 Predictive Onco‐Urology APHP Pitié‐Salpêtrière Hôpital Urology Paris France
| | - Morgan Rouprêt
- Sorbonne University GRC 5 Predictive Onco‐Urology APHP Pitié‐Salpêtrière Hôpital Urology Paris France
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Okhawere KE, Milky G, Shih IF, Li Y, Badani KK. Comparison of 1-Year Health Care Expenditures and Utilization Following Minimally Invasive vs Open Nephrectomy. JAMA Netw Open 2022; 5:e2231885. [PMID: 36112376 PMCID: PMC9482061 DOI: 10.1001/jamanetworkopen.2022.31885] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
IMPORTANCE Given the widespread adoption and clinical benefits of minimally invasive surgery approaches (MIS) in partial nephrectomy (PN) and radical nephrectomy (RN), assessment of long-term cost implications is relevant. OBJECTIVE To compare health care utilization and expenditures within 1 year after MIS and open surgery (OS). DESIGN, SETTING, AND PARTICIPANTS This cohort study was conducted using a US commercial claims database between 2013 and 2018. A total of 5104 patients aged 18 to 64 years who underwent PN or RN for kidney cancer and were continuously insured for 180 days before and 365 days after surgery were identified. An inverse probability of treatment weighting analysis was performed to examine differences in costs and use of health care services. EXPOSURES Surgical approach (MIS or OS). MAIN OUTCOMES AND MEASURES Outcomes assessed included 1-year total health care expenditure, health care utilizations, and estimated days missed from work. RESULTS Of the 5104 patients, 2639 had PN (2008 MIS vs 631 OS) and 2465 had RN (1816 MIS vs 649 OS) and most were male (PN: 1657 [62.8%]; RN: 399 [63.1%]) and between 55 and 64 years of age (PN: 1034 [51.3%]; RN: 320 [55.7%]). Patients who underwent MIS had lower index hospital length of stay compared with OS (mean [95% CI] for PN: 2.45 [2.37-2.53] vs 3.78 [3.60-3.97] days; P < .001; for RN: 2.82 [2.73-2.91] vs 4.62 [4.41-4.83] days; P < .001), and lower index expenditure for RN ($28 999 [$28 243-$29 796] vs $31 977 [$30 729-$33 329]; P < .001). For PN, index expenditure was lower for OS than MIS (mean [95% CI], $27 480 [$26 263-$28 753] vs $30 380 [$29614-$31 167]; P < .001). Patients with MIS had lower 1-year postdischarge readmission rate (PN: 15.1% vs 21.5%; odds ratio [OR], 0.65; 95% CI, 0.52-0.82; P < .001; RN: 15.6% vs 18.9%; OR, 0.79; 95% CI, 0.63-1.00; P = .05), and fewer hospital outpatient visits (mean [95% CI] for PN: 4.69 [4.48-4.90] vs 5.25 [4.84-5.66]; P = .01; RN: 5.50 [5.21-5.80] vs 6.71 [6.12-7.30]; P < .001) than those with OS. For RN, MIS was associated with 1.47 fewer missed workdays (95% CI, 0.57-2.38 days; P = .001). The reduction in health care use in MIS was associated with lower or similar total cumulative expenditures compared with OS (mean difference [95% CI] for PN: $331 [-$3250 to $3912]; P = .85; for RN: -$11 265 [-$17 065 to -$5465]; P < .001). CONCLUSIONS AND RELEVANCE In this cohort study, MIS was associated with lower or similar total cumulative expenditure than OS in the period 1 year after discharge from the index surgery. These findings suggest that downstream expenditures and resource utilization should be considered when evaluating surgical approach for nephrectomy.
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Affiliation(s)
| | | | - I-Fan Shih
- Intuitive Surgical Inc, Sunnyvale, California
| | - Yanli Li
- Intuitive Surgical Inc, Sunnyvale, California
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Zeuschner P, Greguletz L, Meyer I, Linxweiler J, Janssen M, Wagenpfeil G, Wagenpfeil S, Siemer S, Stöckle M, Saar M. Open versus robot‐assisted partial nephrectomy: A longitudinal comparison of 880 patients over 10 years. Int J Med Robot 2020; 17:1-8. [DOI: 10.1002/rcs.2167] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2020] [Revised: 08/26/2020] [Accepted: 09/10/2020] [Indexed: 11/05/2022]
Affiliation(s)
- Philip Zeuschner
- Department of Urology and Pediatric Urology Saarland University Homburg/Saar Germany
| | - Leonie Greguletz
- Department of Urology and Pediatric Urology Saarland University Homburg/Saar Germany
| | - Irmengard Meyer
- Department of Urology and Pediatric Urology Saarland University Homburg/Saar Germany
| | - Johannes Linxweiler
- Department of Urology and Pediatric Urology Saarland University Homburg/Saar Germany
| | - Martin Janssen
- Department of Urology and Pediatric Urology Saarland University Homburg/Saar Germany
| | - Gudrun Wagenpfeil
- Department of Medical Biometry Epidemiology and Medical Informatics Saarland University Homburg/Saar Germany
| | - Stefan Wagenpfeil
- Department of Medical Biometry Epidemiology and Medical Informatics Saarland University Homburg/Saar Germany
| | - Stefan Siemer
- Department of Urology and Pediatric Urology Saarland University Homburg/Saar Germany
| | - Michael Stöckle
- Department of Urology and Pediatric Urology Saarland University Homburg/Saar Germany
| | - Matthias Saar
- Department of Urology and Pediatric Urology Saarland University Homburg/Saar Germany
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Examining and Understanding Value: The Cost of Preoperative Characteristics, Intraoperative Variables and Postoperative Complications of Minimally Invasive Partial Nephrectomy. UROLOGY PRACTICE 2019. [DOI: 10.1016/j.urpr.2018.09.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
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6
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Grivas N, Kalampokis N, Larcher A, Tyritzis S, Rha KH, Ficarra V, Buffi N, Ploumidis A, Autorino R, Porpiglia F, van der Poel H, Mottrie A, de Naeyer G. Robot-assisted versus open partial nephrectomy: comparison of outcomes. A systematic review. MINERVA UROL NEFROL 2019; 71:113-120. [DOI: 10.23736/s0393-2249.19.03391-5] [Citation(s) in RCA: 36] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
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7
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Johnson BA, Crivelli J, Sorokin I, Gahan J, Cadeddu JA. Surgical Outcomes of Three vs Four Arm Robotic Partial Nephrectomy: Is the Fourth Arm Necessary? Urology 2019; 123:140-145. [DOI: 10.1016/j.urology.2018.06.068] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2018] [Revised: 04/05/2018] [Accepted: 06/14/2018] [Indexed: 01/06/2023]
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Tsai SH, Tseng PT, Sherer BA, Lai YC, Lin PY, Wu CK, Stoller ML. Open versus robotic partial nephrectomy: Systematic review and meta-analysis of contemporary studies. Int J Med Robot 2018; 15:e1963. [PMID: 30265760 DOI: 10.1002/rcs.1963] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2018] [Revised: 09/13/2018] [Accepted: 09/21/2018] [Indexed: 01/17/2023]
Abstract
OBJECTIVES To compare perioperative outcomes of robotic-assisted partial nephrectomy (RaPN) with open partial nephrectomy (OPN). METHODS Systematically search through PubMed, Embase, ClinicalKey, Cochrane Library, ProQuest, ScienceDirect, Web of Science, and ClinicalTrials.gov for eligible studies was performed to April 11, 2018. A meta-analysis was conducted for studies comparing RaPN and OPN. Confounding variables were assessed by meta-regression or subgroup analysis. RESULTS This study included 34 studies with 60 808 patients. Meta-analysis revealed less blood loss, less transfusion, longer operative time, less postoperative complications, lower readmission rate, shorter length of stay, and less estimated glomerular filtration rate (eGFR) decline in RaPN groups. The superiority of RaPN in blood loss was attenuated with highly complex renal masses. The superiority of RaPN in intraoperative complications was strengthened with renal hilar control. The advantage of RaPN in surgical margin was increased in patient with body mass index (BMI) < 28. CONCLUSIONS Compared with OPN, RaPN provided lower morbidities and better renal function preservation.
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Affiliation(s)
- Sheng-Han Tsai
- Department of Urology, Cheng Hsin General Hospital, Taipei City, Taiwan.,School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Ping-Tao Tseng
- Department of Psychiatry, Tsyr-Huey Mental Hospital, Kaohsiung, Taiwan.,WinShine Clinics in Specialty of Psychiatry, Kaohsiung, Taiwan
| | - Benjamin A Sherer
- Department of Urology, University of California, San Francisco, San Francisco, California
| | - Yi-Chen Lai
- School of Medicine, National Yang-Ming University, Taipei, Taiwan.,Department of Radiology, Veteran General Hospital, Taipei, Taiwan
| | - Pao-Yen Lin
- Department of Psychiatry, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan.,Institute for Translational Research in Biomedical Sciences, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan
| | - Ching-Kuan Wu
- Department of Psychiatry, Tsyr-Huey Mental Hospital, Kaohsiung, Taiwan
| | - Marshall L Stoller
- Department of Urology, University of California, San Francisco, San Francisco, California
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9
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Buse S, Hach CE, Klumpen P, Schmitz K, Mager R, Mottrie A, Haferkamp A. Cost-effectiveness analysis of robot-assisted vs. open partial nephrectomy. Int J Med Robot 2018; 14:e1920. [DOI: 10.1002/rcs.1920] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2017] [Revised: 03/18/2018] [Accepted: 04/01/2018] [Indexed: 01/01/2023]
Affiliation(s)
- Stephan Buse
- Department of Urology and Urologic Oncology; Alfried Krupp Krankenhaus; Essen Germany
- Department of Urology and Pediatric Urology; University Medical Center, Johannes-Gutenberg-University; Mainz Germany
| | - Carolin E. Hach
- Department of Urology and Urologic Oncology; Alfried Krupp Krankenhaus; Essen Germany
| | - Phillip Klumpen
- Department of Urology and Urologic Oncology; Alfried Krupp Krankenhaus; Essen Germany
| | - Karoline Schmitz
- Department of Urology and Urologic Oncology; Alfried Krupp Krankenhaus; Essen Germany
| | - Rene Mager
- Department of Urology and Pediatric Urology; University Medical Center, Johannes-Gutenberg-University; Mainz Germany
| | - Alexandre Mottrie
- OLV Vattikuti Robotic Surgery Institute; OLV Hospital Aalst; Aalst Belgium
- Department of Urology; OLV Hospital Aalst; Aalst Belgium
| | - Axel Haferkamp
- Department of Urology and Pediatric Urology; University Medical Center, Johannes-Gutenberg-University; Mainz Germany
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10
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Xia L, Wang X, Xu T, Guzzo TJ. Systematic Review and Meta-Analysis of Comparative Studies Reporting Perioperative Outcomes of Robot-Assisted Partial Nephrectomy Versus Open Partial Nephrectomy. J Endourol 2017; 31:893-909. [DOI: 10.1089/end.2016.0351] [Citation(s) in RCA: 80] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Affiliation(s)
- Leilei Xia
- Division of Urology, Department of Surgery, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania
| | - Xianjin Wang
- Department of Urology, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, P.R. China
| | - Tianyuan Xu
- Department of Urology, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, P.R. China
| | - Thomas J. Guzzo
- Division of Urology, Department of Surgery, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania
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11
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12
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Shen Z, Xie L, Xie W, Hu H, Chen T, Xing C, Liu X, Xu H, Zhang Y, Wu Z, Tian D, Wu C. The comparison of perioperative outcomes of robot-assisted and open partial nephrectomy: a systematic review and meta-analysis. World J Surg Oncol 2016; 14:220. [PMID: 27549155 PMCID: PMC4994255 DOI: 10.1186/s12957-016-0971-9] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2015] [Accepted: 08/03/2016] [Indexed: 12/27/2022] Open
Abstract
Background Robot-assisted partial nephrectomy (RAPN) has been widely used worldwide, to determine whether RAPN is a safe and effective alternative to open partial nephrectomy (OPN) via the comparison of RANP and OPN. Methods A comprehensive literature search was performed within the databases including PubMed, Cochrane Library, and Embase updated on 30 September 2015. Summary data with their corresponding 95 % confidence intervals (CIs) were calculated using a random effects or fixed effects model. Heterogeneity and publication bias were also evaluated. Results A total of 16 comparative studies including 3024 cases were used for this meta-analysis. There are no significant differences in the demographic characteristic between the two groups, but the age was lower and the tumor size was smaller for the RAPN group. RAPN had a longer operative time and warm ischemia time but which showed less estimated blood loss, hospital stay, and perioperative complications. No differences existed in the margin status, the change of glomerular filtration rate, transfusion rate, and conversion rate between the two groups. There was no significant publication bias. Conclusions RAPN offered a lower rate of perioperative complications, less estimated blood loss, and shorter length of hospital stay than OPN, suggesting that RAPN can be an effective alternative to OPN. Well-designed prospective randomized controlled trials will be helpful in validating our findings.
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Affiliation(s)
- Zhonghua Shen
- Department of Urology, The Second Hospital of Tianjin Medical University, Pingjiang Road 23, Hexi District, Tianjin, 300211, China.,Tianjin Key Laboratory of Urology, Tianjin Institute of Urology, the Second Hospital of Tianjin Medical University, Tianjin, 300211, China
| | - Linguo Xie
- Department of Urology, The Second Hospital of Tianjin Medical University, Pingjiang Road 23, Hexi District, Tianjin, 300211, China.,Tianjin Key Laboratory of Urology, Tianjin Institute of Urology, the Second Hospital of Tianjin Medical University, Tianjin, 300211, China
| | - Wanqin Xie
- Key Laboratory of Genetics and Birth Health of Hunan Province, The Family Planning Research Institute of Hunan Province, Changsha, Hunan, 410126, China
| | - Hailong Hu
- Department of Urology, The Second Hospital of Tianjin Medical University, Pingjiang Road 23, Hexi District, Tianjin, 300211, China.,Tianjin Key Laboratory of Urology, Tianjin Institute of Urology, the Second Hospital of Tianjin Medical University, Tianjin, 300211, China
| | - Tao Chen
- Department of Urology, The Second Hospital of Tianjin Medical University, Pingjiang Road 23, Hexi District, Tianjin, 300211, China.,Tianjin Key Laboratory of Urology, Tianjin Institute of Urology, the Second Hospital of Tianjin Medical University, Tianjin, 300211, China
| | - Chen Xing
- Department of Urology, The Second Hospital of Tianjin Medical University, Pingjiang Road 23, Hexi District, Tianjin, 300211, China.,Tianjin Key Laboratory of Urology, Tianjin Institute of Urology, the Second Hospital of Tianjin Medical University, Tianjin, 300211, China
| | - Xiaoteng Liu
- Department of Urology, The Second Hospital of Tianjin Medical University, Pingjiang Road 23, Hexi District, Tianjin, 300211, China
| | - Hao Xu
- Department of Urology, The Second Hospital of Tianjin Medical University, Pingjiang Road 23, Hexi District, Tianjin, 300211, China.,Tianjin Key Laboratory of Urology, Tianjin Institute of Urology, the Second Hospital of Tianjin Medical University, Tianjin, 300211, China
| | - Yu Zhang
- Department of Urology, The Second Hospital of Tianjin Medical University, Pingjiang Road 23, Hexi District, Tianjin, 300211, China.,Tianjin Key Laboratory of Urology, Tianjin Institute of Urology, the Second Hospital of Tianjin Medical University, Tianjin, 300211, China
| | - Zhouliang Wu
- Department of Urology, The Second Hospital of Tianjin Medical University, Pingjiang Road 23, Hexi District, Tianjin, 300211, China.,Tianjin Key Laboratory of Urology, Tianjin Institute of Urology, the Second Hospital of Tianjin Medical University, Tianjin, 300211, China
| | - Dawei Tian
- Department of Urology, The Second Hospital of Tianjin Medical University, Pingjiang Road 23, Hexi District, Tianjin, 300211, China. .,Tianjin Key Laboratory of Urology, Tianjin Institute of Urology, the Second Hospital of Tianjin Medical University, Tianjin, 300211, China.
| | - Changli Wu
- Department of Urology, The Second Hospital of Tianjin Medical University, Pingjiang Road 23, Hexi District, Tianjin, 300211, China. .,Tianjin Key Laboratory of Urology, Tianjin Institute of Urology, the Second Hospital of Tianjin Medical University, Tianjin, 300211, China.
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Chirurgie robot-assistée en uro-oncologie. ONCOLOGIE 2016. [DOI: 10.1007/s10269-016-2622-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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14
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Özkan B, Coşkuner ER, Yalçın V. Robotic-assisted partial nephrectomy without using ureteral stent: a single center experience. Turk J Urol 2016; 42:1-6. [PMID: 27011873 DOI: 10.5152/tud.2016.36786] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
OBJECTIVE To share our results of robotic assisted partial nephrectomy (RAPN) we performed without using ureteral stent in a single center from Turkey. MATERIAL AND METHODS Medical records of consecutive 45 patients (34 men and 11 women) who underwent RAPN for kidney lesions between March 2011 and December 2014 were retrieved, and evaluated. All the procedures were performed by a transperitoneal approach without using ureteral stent prior to surgery. Renal artery clamping was used in all cases and intraoperative ultrasonography was used in 2 cases. RESULTS Patients undergoing RAPN had a mean tumor size of 4.42 cm (2-8) and a mean renal nephrometry score of 5.82 (4-11). The mean estimated blood loss was 250 mL (150-450 ml) and the mean operative time was 195 minutes (150-300). There was no statistical difference between the preoperative and postoperative serum creatinine levels at the first follow-up visit (0.9 vs. 0.95, p=0.087). Surgical margin positivity was not detected in any patient, and the mean surgical margin distance was calculated as 0.4 mm (0.2-10). In only 1 patient disease recurrence was detected at the 21(st) month of the the follow-up period, and no distant metastases was reported in our patients at a mean follow-up of 10 months (3-36 mos). Our complication rate was 11.1% and according to the Clavien system complications were as; grade 2 (3 patients), grade 3a (1 patient) and grade 3b (1 patient). CONCLUSION With appropriately selected patients and adequate surgical experience, RAPN performed without using ureteral stent is a safe and feasible method for localized renal tumors.
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Affiliation(s)
- Burak Özkan
- Department of Urology, Acıbadem University School of Medicine, İstanbul, Turkey
| | - Enis Rauf Coşkuner
- Department of Urology, Acıbadem University School of Medicine, İstanbul, Turkey
| | - Veli Yalçın
- Department of Urology, Bakırköy Acıbadem Hospital, İstanbul, Turkey
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Abd El Fattah V, Chevrot A, Meusy A, Mercier G, Wagner L, Soustelle L, Boukaram M, Thuret R, Costa P, Droupy S. [Cost comparison of open and robot-assisted partial nephrectomy in treatment of renal tumor]. Prog Urol 2016; 26:295-303. [PMID: 26971674 DOI: 10.1016/j.purol.2016.02.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2015] [Revised: 01/18/2016] [Accepted: 02/05/2016] [Indexed: 11/27/2022]
Abstract
INTRODUCTION Robot-assisted partial nephrectomy rapidly took on among urologists, even though studies showing its superiority over other techniques are still scarce and its costs hard to evaluate, especially in the French medical system. OBJECTIVE To evaluate the cost overrun of robot-assisted partial nephrectomy compared to that of open partial nephrectomy. EQUIPMENT AND METHODS From January 2010 to December 2013, 77 patients underwent a partial nephrectomy, 46 of which by robot-assisted laparoscopy and the remaining 31 by lombotomy. The two groups were similar in composition. Economic data regarding the staff, the consumables and the premises involved have been analyzed. RESULTS Costs are significantly higher in the NPR group (9253.21 euros vs. 7448.42 euros) due to higher consumable expenses as well as the costs pertaining to the amortization and maintenance of the robot. Yet, that difference tends to diminish as the duration of the experiment increases. No significant difference was found in warm ischemia times, operation duration and renal function a month after the operation. On the other hand, patients from the NPR group spent a significantly smaller amount of time in recovery room (159 minutes vs. 205 minutes, P=0.004), presented fewer complications and were discharged faster (6.1 days vs. 8.1 days, P=0.04). CONCLUSIONS To be profitable for the hospital in the French GHS system, robot-assisted partial nephrectomy must take place in a complex where at least 300 robot-assisted interventions are performed annually, in the framework of a hospitalization lasting four days or less, the use of a single needle holder and no systematic use of a haemostatic agent. LEVEL OF EVIDENCE 4.
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Affiliation(s)
- V Abd El Fattah
- Service d'urologie-andrologie, CHU Carémeau, place du Professeur-Robert-Debré, 30029 Nîmes cedex 09, France.
| | - A Chevrot
- Service d'urologie-andrologie, CHU Carémeau, place du Professeur-Robert-Debré, 30029 Nîmes cedex 09, France
| | - A Meusy
- Département d'information médicale, CHU Lapeyronie, 191, avenue du Doyen-Gaston-Giraud, 34295 Montpellier cedex 5, France
| | - G Mercier
- Département d'information médicale, CHU Lapeyronie, 191, avenue du Doyen-Gaston-Giraud, 34295 Montpellier cedex 5, France
| | - L Wagner
- Service d'urologie-andrologie, CHU Carémeau, place du Professeur-Robert-Debré, 30029 Nîmes cedex 09, France
| | - L Soustelle
- Service d'urologie-andrologie, CHU Carémeau, place du Professeur-Robert-Debré, 30029 Nîmes cedex 09, France
| | - M Boukaram
- Service d'urologie-andrologie, CHU Carémeau, place du Professeur-Robert-Debré, 30029 Nîmes cedex 09, France
| | - R Thuret
- Service d'urologie-andrologie, CHU Lapeyronie, 191, avenue du Doyen-Gaston-Giraud, 34295 Montpellier cedex 5, France
| | - P Costa
- Service d'urologie-andrologie, CHU Carémeau, place du Professeur-Robert-Debré, 30029 Nîmes cedex 09, France
| | - S Droupy
- Service d'urologie-andrologie, CHU Carémeau, place du Professeur-Robert-Debré, 30029 Nîmes cedex 09, France
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Are we ready for day-case partial nephrectomy? World J Urol 2015; 34:883-7. [DOI: 10.1007/s00345-015-1746-6] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2015] [Accepted: 12/07/2015] [Indexed: 12/21/2022] Open
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Tandogdu Z, Vale L, Fraser C, Ramsay C. A Systematic Review of Economic Evaluations of the Use of Robotic Assisted Laparoscopy in Surgery Compared with Open or Laparoscopic Surgery. APPLIED HEALTH ECONOMICS AND HEALTH POLICY 2015; 13:457-67. [PMID: 26239361 DOI: 10.1007/s40258-015-0185-2] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
Abstract
BACKGROUND Robot assisted laparoscopic (RAL) surgery developed to overcome the limitations of laparoscopy to assist in surgical procedures, has high capital and operating costs. Systematically assembled evidence demonstrating its clinical and cost effectiveness would be helpful for its adoption by decision makers. OBJECTIVE To summarise the evidence on the cost-effectiveness of robot-assisted laparoscopic (RAL) surgery compared with relevant alternatives. Methods and results of identified studies were assessed to identify the deficiencies in evidence and areas for further research. METHODS Studies reporting both costs and outcomes for comparisons of RAL with laparoscopy and/or open surgery were systematically identified. Searches were conducted in February 2015 on MEDLINE, EMBASE and NHS EED. Quality of the included studies was assessed against a standard checklist for economic analyses. Length of hospital stay and operating time (determinants of cost), cost of intervention, quality-adjusted life-years (QALYs) and incremental cost-effectiveness ratio (ICER) were extracted. To aid comparison, costs were converted into a common currency and price year (2014 US dollars). RESULTS Forty-seven eligible studies were identified (full economic evaluation n = 6 and cost analysis n = 41). Economic models were used in 11 (23%) studies. Only three studies used a model considered representative of the disease and clinical pathway with a time-horizon allowing capture of relevant differences in outcomes across strategies. The cost of RAL varied substantially between uses, ranging from US$7011 for hysterectomy to over US$30,000 for radical cystectomy. The majority of estimates were between US$15,000 and US$25,000 per person. In part this difference is explained by the difference between studies in which costs were included. It was also identified to have higher costs than the alternatives it was compared against. Incremental cost per QALY for RAL radical prostatectomy was US$28,801-$31,763 over a 10-year period assuming 200 cases per annum. CONCLUSION The clinical evidence available for RAL overall and used within included studies is limited. RAL surgery costs were consistently higher than open and laparoscopic surgery. Therefore, in adopting the robotic technology decision makers need to take into account the cost effectiveness within their own systems. Economic models generated and published for radical prostatectomy and hysterectomy may be adapted to other health systems if the care pathway is similar to provide locally relevant data.
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Affiliation(s)
- Zafer Tandogdu
- Northern Institute for Cancer Research, Newcastle University, Newcastle Upon Tyne, UK
- Health Economics Group, Institute of Health and Society, Newcastle University, Newcastle Upon Tyne, UK
| | - Luke Vale
- Health Economics Group, Institute of Health and Society, Newcastle University, Newcastle Upon Tyne, UK
| | - Cynthia Fraser
- Health Services Research Unit, University of Aberdeen, 3rd Floor, Health Sciences Building, Foresterhill, Aberdeen, AB25 2ZD, UK
| | - Craig Ramsay
- Health Services Research Unit, University of Aberdeen, 3rd Floor, Health Sciences Building, Foresterhill, Aberdeen, AB25 2ZD, UK.
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Kim FJW, da Silva RD. Editorial Comment. Urology 2015; 86:945. [PMID: 26343238 DOI: 10.1016/j.urology.2015.05.048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Affiliation(s)
- Fernando J W Kim
- Division of Urology, Department of Surgery, Denver Health Medical Center, Denver, CO
| | - Rodrigo D da Silva
- Division of Urology, Department of Surgery, Denver Health Medical Center, Denver, CO
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Tan HJ. Editorial comment. Urology 2015; 85:603. [PMID: 25586475 DOI: 10.1016/j.urology.2014.10.045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Affiliation(s)
- Hung-Jui Tan
- VA/UCLA Robert Wood Johnson Clinical Scholars Program, University of California, Los Angeles, CA; Department of Urology, University of California, Los Angeles, CA
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