Does Advancing Technology Improve Outcomes? Comparison of the Da Vinci Standard/S/Si to the Xi Robotic Platforms During Robotic Nephroureterectomy

摘要

Introduction: With the introduction of laparoscopy and now robotics, more patients are able to reap benefit from minimally invasive techniques during urologic surgery. With these advancing technologies, it is important to evaluate whether the outlay of hospital capital actually improves patient care. To date, there has been little literature regarding the impact of these advances on patient outcomes. In this article, we directly compare perioperative outcomes and hospital costs between the older da Vinci Standard/S/Si platform and the newer Xi robotic platform during nephroureterectomy. Methods: A review of our robotic nephroureterectomy database between April 2009 and December 2017 identified 87 patients, 30 in group 1 (Xi) and 57 in group 2 (Standard/S/Si). Preoperative, perioperative, and postoperative parameters as well as hospital costs were evaluated. Independent t -test was performed for continuous variables, while categorical variables were evaluated using chi-square tests or Fisher's exact test. Results: There were no significant differences between groups preoperatively. Operative time using the Xi was shorter, 184.4 vs 232.09 minutes ( p = 0.0035). Other perioperative variables were similar. There was more lymphovascular invasion in group 2 ( p = 0.0108), but there were higher stage tumors in group 1 ( p < 0.0001). More patients underwent lymph node dissection in group 1 ( p = 0.0186). Complications were similar between groups. Costs for anesthesia were less in group 1, which led to decreased total hospitalization costs ( p < 0.001) Conclusion: Operative times were found to be less with the daVinci Xi, without any other significant difference in patient outcomes between the groups. Anesthesia and operating room cost were substantial factors in lowering the overall hospital costs. More multi-institutional studies with larger groups of patients are needed to determine if advancing technology really improves outcomes.