Healthcare Improvement Scotland 18 January 2018
Key points
- No randomised controlled trials were identified comparing robot assisted laparascopic partial nephrectomy (RALPN) with open partial nephrectomy (OPN) or with conventional laparascopic partial nephrectomy (LPN).
- The evidence base consists of meta-analyses of short-term observational studies, many of which are retrospective and at high risk of bias. In these studies: RALPN is associated with fewer postoperative complications, less blood loss and shorter length of hospital stay than OPN, with no statistically significant differences between study groups in rate of positive surgical margins or degree of decline in estimated glomerular filtration rate (eGFR). RALPN is associated with shorter warm ischaemia time, reduced eGFR decline and a lower rate of conversion to open surgery or radical nephrectomy than LPN. There was no statistically significant difference between study groups in positive surgical margin rate or post-operative complications. RALPN is associated with shorter length of hospital stay than LPN.
- One US cost-effectiveness analysis reported an incremental (2014) cost per avoided peri-operative complication of $5,005 (£3,877) when comparing RALPN with OPN.
- In a retrospective analysis of routinely collected NHS data RALPN was associated with reduced 90-day complication costs and total medical costs at one year when compared with OPN. Differences between LPN and RALPN were not statistically significant.
- Evidence was insufficient to characterise the learning curve associated with initial experience in RALPN or to determine minimum surgeon or hospital case volume.
