Robot-assisted nephrectomy could increase costs, procedure time

Robot-assisted surgery may be worthwhile for certain procedures, but the helping hand could extend operating times and increase costs of traditional procedures, according to a study published in JAMA.

Robot-assisted laparoscopic surgery to remove a patient's entire kidney could be unnecessary, according to researchers from the Stanford University School of Medicine who evaluated the difference in using robot versus traditional methods of nephrectomy. While robot-assisted removal of a portion of the kidney results in a greater accuracy, removal of the entire kidney does not require such technical assistance and does not offer any additionally benefit to the patient.

"There is a certain incentive to use very expensive equipment," said Benjamin Chung, MD, associate professor of urology and senior author of the study. "But it is also important to be cognizant as to how our health care dollars are being spent. Although robotic surgery has some advantages, are those advantages relevant enough in this type of case to justify an increase in cost?"

The study analyzed rates of robot-assisted nephrectomies and found that from 2003 to 2015, the rate has increased from 23 percent of surgeries to 27 percent. When analyzing the difference in traditional and robot-assisted nephrectomies, researchers evaluated 24,000 patients, 19,000 having had a traditional laparoscopic procedure and 5,000 undergoing a robot-assisted procedure.

Results showed 46.3 percent of robotic procedure patients experienced a procedure time longer than four hours, compared to 28.5 percent of traditional laparoscopic patients. Additionally, robotic surgeries cost an average of $2,700 more than traditional laparoscopic procedures.

"Although the laparoscopic procedure has been standard of care for a radical nephrectomy for many years, we saw an increase in the use of robotic-assisted approaches, and by 2015 these had surpassed the number of conventional laparoscopic procedures," said Chung. "We found that, although there was no statistical difference in outcome or length of hospital stay, the robotic-assisted surgeries cost more and had a higher probability of prolonged operative time."