2015
DOI: 10.1097/mlr.0000000000000259
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The Effect of the Diffusion of the Surgical Robot on the Hospital-level Utilization of Partial Nephrectomy

Abstract: Introduction The rapid diffusion of the surgical robot has been controversial because of the technology’s high costs and its disputed marginal benefit. Some, however, have suggested that adoption of the robot may have improved care for patients with renal malignancy by facilitating partial nephrectomy, an underutilized, technically challenging procedure believed to be less morbid than radical nephrectomy. We sought to determine whether institutional acquisition of the robot was associated with increased utiliz… Show more

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Cited by 41 publications
(17 citation statements)
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“…The majority of patients underwent RAPN (76.3%, n = 545). Both approaches were similar with regard to age, gender, race, CCI, preoperative eGFR and clinical tumour size ( [5][6][7][8]; P < 0.001). Although the overall rate of intra-operative complications did not differ between groups (OPN 1.8% vs RAPN 1.7%; P = 1.0), patients in the open cohort were more likely to require intra-operative transfusions (3% vs 0.7%; P = 0.038).…”
Section: Case Characteristics and Operative Detailsmentioning
confidence: 88%
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“…The majority of patients underwent RAPN (76.3%, n = 545). Both approaches were similar with regard to age, gender, race, CCI, preoperative eGFR and clinical tumour size ( [5][6][7][8]; P < 0.001). Although the overall rate of intra-operative complications did not differ between groups (OPN 1.8% vs RAPN 1.7%; P = 1.0), patients in the open cohort were more likely to require intra-operative transfusions (3% vs 0.7%; P = 0.038).…”
Section: Case Characteristics and Operative Detailsmentioning
confidence: 88%
“…Dissemination and availability of robotic technology has increased the utilization of NSS for the management of renal tumours by decreasing the learning curve, thus making the approach more accessible to community surgeons [4,5].…”
Section: Discussionmentioning
confidence: 99%
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“…19 At the same time, providers were becoming more comfortable performing robotic kidney surgery, which uses similar port placement and requires similar steps to expose the kidney and ureter. 20 The patients who received open and minimally invasive pyeloplasties had many similarities. They did not differ in terms of age, number of comorbidities, type of health plan, or area of residence (in terms of region and urbanicity).…”
Section: Discussionmentioning
confidence: 99%
“…In synthesizing these data, we must also appreciate the evolving risk profile of partial vs. radical nephrectomy. The accumulation of experience, implementation of clinical pathways, and rise of the robotic platform have modernized surgical delivery, making partial nephrectomy less morbid (at least for recovery) and more accessible to the population at large [20,39,40]. Patients and providers also have alternative management strategies to consider, such as ablation and surveillance.…”
Section: Commentarymentioning
confidence: 98%