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Open Access 01-12-2014 | Research article

Robotic radical nephrectomy for renal cell carcinoma: a systematic review

Authors: Anastasios D Asimakopoulos, Roberto Miano, Filippo Annino, Salvatore Micali, Enrico Spera, Beniamino Iorio, Giuseppe Vespasiani, Richard Gaston

Published in: BMC Urology | Issue 1/2014

Abstract

Background

Laparoscopic radical nephrectomy (LRN) is the actual gold-standard for the treatment of clinically localized renal cell carcinoma (RCC) (cT1-2 with no indications for nephron-sparing surgery). Limited evidence is currently available on the role of robotics in the field of radical nephrectomy. The aim of the current study was to provide a systematic review of the current evidence on the role of robotic radical nephrectomy (RRN) and to analyze the comparative studies between RRN and open nephrectomy (ON)/LRN.

Methods

A Medline search was performed between 2000–2013 with the terms “robotic radical nephrectomy”, “robot-assisted laparoscopic nephrectomy”, “radical nephrectomy”. Six RRN case-series and four comparative studies between RRN and (ON)/pure or hand-assisted LRN were identified.

Results

Current literature produces a low level of evidence for RRN in the treatment of RCC, with only one prospective study available. Mean operative time (OT) ranges between 127.8-345 min, mean estimated blood loss (EBL) ranges between 100–273.6 ml, and mean hospital stay (HS) ranges between 1.2-4.3 days. The comparison between RRN and LRN showed no differences in the evaluated outcomes except for a longer OT for RRN as evidenced in two studies. Significantly higher direct costs and costs of the disposable instruments were also observed for RRN. The comparison between RRN and ON showed that ON is characterized by shorter OT but higher EBL, higher need of postoperative analgesics and longer HS.

Conclusions

No advantage of robotics over standard laparoscopy for the treatment of clinically localized RCC was evidenced. Promising preliminary results on oncologic efficacy of RRN have been published on the T3a-b disease. Fields of wider application of robotics should be researched where indications for open surgery still persist.

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The pre-publication history for this paper can be accessed here:http://www.biomedcentral.com/1471-2490/14/75/prepub

Title: Robotic radical nephrectomy for renal cell carcinoma: a systematic review
Authors: Anastasios D Asimakopoulos
Roberto Miano
Filippo Annino
Salvatore Micali
Enrico Spera
Beniamino Iorio
Giuseppe Vespasiani
Richard Gaston
Publication date: 01-12-2014
Publisher: BioMed Central
Published in: BMC Urology / Issue 1/2014
Electronic ISSN: 1471-2490
DOI: https://doi.org/10.1186/1471-2490-14-75

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Robotic radical nephrectomy for renal cell carcinoma: a systematic review

Abstract

Background

Methods

Results

Conclusions

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Abstract

Background

Methods

Results

Conclusions

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