Evidence Synthesis Program (ESP) Center West Los Angeles
VA Medical Center
Los Angeles, CA
Paul G. Shekelle, MD, PhD, Director
Maggard-Gibbons M, Childers CP, Girgis M, Lamaina M, Tang A, Ruan Q, Mak SS. Begashaw M, Booth MS, Shekelle PG, Robotic-Assisted Surgery in Partial Nephrectomy and Cystectomy. Los Angeles: Evidence Synthesis Program, Health Services Research and Development Service, Office of Research and Development, Department of Veterans Affairs. VA ESP Project #05-226; 2019.
The adoption of robotic surgery continues to increase, although there remain questions concerning the utility of the robotic approach as compared to both laparoscopic and open surgery. One question that remains is whether the technical advantages of this approach translate into better clinical outcomes for patients - or at least similar. Recent studies have raised concerns that for some operations the oncologic outcomes may be worse. Further complicating the debate is the economics of the robotic platform and whether or not the benefits balance the tradeoff of increased costs.
The robotic approach is widely used across urology, with over 125,000 procedures performed in 2017. In light of recent evidence questioning the utility of the robotic platform, it is important to re-visit the evidence surrounding the use of the robotic platform in urologic surgery, especially for long-term clinical and oncologic outcomes. And while the robotic approach has become the standard approach to prostatectomy, there are other urologic procedures - namely partial nephrectomy and cystectomy - where the introduction of the robotic approach is occurring, and an evidence synthesis is warranted.
To help clinicians, patients, and policymakers decide between robotic and other surgical approaches in patients undergoing partial nephrectomy and cystectomy, we were asked to conduct a systematic review of the literature.
KQ1A: What is the clinical effectiveness of robotic-assisted surgery compared to open surgery or conventional laparoscopic surgery for cystectomy?
KQ1B: What is the cost effectiveness of robotic-assisted surgery compared to open surgery or conventional laparoscopic surgery for cystectomy?
KQ2A: What is the clinical effectiveness of robotic-assisted surgery compared to open surgery or conventional laparoscopic surgery for partial nephrectomy?
KQ2B: What is the cost effectiveness of robotic-assisted surgery compared to open surgery or conventional laparoscopic surgery for partial nephrectomy?
Tang AB, Lamaina M, Childers CP, et al. Perioperative and Long-Term Outcomes of Robot-Assisted Partial Nephrectomy: A Systematic Review. Am Surg. 2020 Sep 9:3134820948912. doi: 10.1177/0003134820948912. Epub ahead of print. PMID: 32902308.