Outcomes of robotic-assisted radical nephrectomy during service implementation: Lessons from an audit

Area of Science:

• Urology
• Surgical Technology
• Minimally Invasive Surgery

Background:

• Robot-assisted surgery (RAS) is increasingly adopted for various surgical procedures.
• Radical nephrectomy (RN) is a common urological procedure.
• Evaluating the impact of RAS implementation is crucial for surgical services.

Purpose of the Study:

• To assess the impact of RAS on the radical nephrectomy (RN) service during its implementation phase.
• To compare outcomes before and after RAS implementation.
• To directly compare robotic-assisted radical nephrectomies (RARNs) with laparoscopic radical nephrectomies (LRNs).

Main Methods:

• Two comparative analyses were performed: all RNs (pre- vs. post-RAS) and direct comparison of RARNs vs. LRNs.
• Data included 55 pre-robotic and 45 robotic era RNs, with specific breakdowns for RARNs, LRNs, and open radical nephrectomies (ORNs).
• Perioperative outcomes were evaluated, including operative time, blood loss, and length of hospital stay.

Main Results:

• Following RAS implementation, all RNs transitioned to RARNs, eliminating ORNs and LRNs.
• Comparison of all RNs showed significant reductions in estimated blood loss and hospital stay post-RAS implementation.
• Operative times were longer in the robotic era, with RARNs showing no major perioperative differences compared to LRNs, except for longer operative duration.

Conclusions:

• The introduction of RAS led to a paradigm shift in RN service, with RARNs becoming the primary approach.
• RARNs demonstrated improved perioperative outcomes, specifically reduced blood loss and shorter hospital stays, despite longer operative times.
• RAS was favored over traditional open and laparoscopic methods for radical nephrectomy.