New Study Finds That Robotically Assisted Surgery for Kidney Cancer Increases Access to Partial Versus Radical Nephrectomy, Reducing Mortality, Renal Failure and Long-Term Costs
The Precision Health Economics (PHE) study set out to determine if the investment in a surgical robot could be linked to improvements in long-term patient outcomes. The study found that partial nephrectomies had significantly lower rates of renal failure when compared with radical nephrectomies. The study also concluded that the costs incurred in adopting robotic-assisted surgery were offset by higher survival and lower renal impairment rates.
"Partial nephrectomy, or kidney-sparing surgery, is considered the standard of care for clinically appropriate patients as a means to slow the progression of renal failure and reduce the risk of dialysis," said Dr.
"The preferred and healthiest option to cure a small renal cancer is to perform a partial nephrectomy," said
Approximately 297,000 nephrectomies were performed in
"This study demonstrates the benefits – and pitfalls – of comparative research," said
Of note, the study found no evidence that the availability of robot-assisted MIS increased the likelihood that inappropriate patients received partial nephrectomy. The study did find that use of robotically assisted surgery might increase access to partial nephrectomy, which is associated with improvements in one-year survival rates after surgery and large reductions in renal failure rates. HRRs most likely to offer partial nephrectomy attained significantly lower rates of renal failure in all three time periods studied.
The PHE study found that partial nephrectomy improved one-year mortality by 5.7 percentage points. In comparison,
The study used national cancer registry data linked with
The study focused on kidney cancer, and the results may not be generalizable to other cancers.
The data were restricted to
PHE conceptualized, designed, conducted the data analysis and managed the study.
About the da Vinci Surgical System
The da Vinci Surgical System is a surgical platform designed to enable complex surgery using a minimally invasive approach. The da Vinci Surgical System consists of an ergonomic surgeon console or consoles, a patient-side cart with three or four interactive arms, a high-performance vision system and proprietary EndoWrist® instruments. Powered by state-of-the-art technology, the da Vinci Surgical System is designed to scale, filter and seamlessly translate the surgeon's hand movements into more precise movements of the EndoWrist instruments. The net result is an intuitive interface with improved surgical capabilities. By providing surgeons with superior visualization, enhanced dexterity, greater precision and ergonomic comfort, the da Vinci Surgical System makes it possible for skilled surgeons to perform more minimally invasive procedures involving complex dissection or reconstruction. Potential benefits are specific to the procedure as well as the model da Vinci System referenced in the footnoted publications. For more information about clinical evidence related to da Vinci Surgery, please visit www.intuitivesurgical.com/company/clinical-evidence/.
Negative outcomes, risks, and complications of nephrectomy and partial nephrectomy include: poor kidney function often due to limited blood flow, leaking of urine, cut or tear in the spleen, bowel injury, trapped air between the chest wall and lung, injury to diaphragm (muscle separating the chest from the abdomen), urinary fistula (abnormal bond of an organ, intestine or vessel to another part of the body), abnormal pooling of urine, limited or cut off blood supply to kidney, abnormal pooling of lymph fluid.
All surgery presents risk, including da Vinci® Surgery and other minimally invasive procedures. Serious complications may occur in any surgery, up to and including death. Examples of serious or life-threatening complications, which may require prolonged or unexpected hospitalization, include injury to tissues and/or organs, bleeding, infection and/or internal scarring that can cause long-lasting dysfunction and/or pain. Risks of surgery also include the potential for equipment failure and/or human error. Results, including cosmetic results, may vary.
Risks specific to minimally invasive surgery, including da Vinci Surgery, include temporary pain and/or nerve injury associated with positioning; temporary pain and/or discomfort from the presence of air or gas; a longer operation and time under anesthesia and conversion to another technique. If your surgeon needs to convert the surgery to another technique, this could result in a longer operative time, additional time under anesthesia, additional or larger incisions and/or increased complications.
Patients who bleed easily, who have abnormal blood clotting, are pregnant or morbidly obese may not be candidates for minimally invasive surgery, including da Vinci Surgery. Patients should talk to their doctor about his/her surgical experience and to decide if da Vinci Surgery is right for them. Patients and physicians should review all available information on non-surgical and surgical options in order to make an informed decision. For important safety information, including surgical risks and indications and contraindications for use, please also refer to www.davincisurgery.com.
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1 Tan HJ, Norton EC, Ye Z, Hafez KS, Gore JL, Miller DC. Long-term survival following partial vs radical nephrectomy among older patients with early-stage kidney cancer. JAMA. 2012;307(15):1629–35.
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