Comparative outcomes and costs of robotic assisted, laparoscopic, and open partial nephrectomy: a contemporary analysis of national inpatient sample data

TL;DR

This study compares robotic, laparoscopic, and open partial nephrectomy techniques in the U.S., finding that minimally invasive methods have better outcomes and lower costs than open surgery.

Contribution

The study provides contemporary national data on the utilization, outcomes, and costs of three partial nephrectomy approaches in U.S. renal cancer patients.

Findings

Robotic-assisted partial nephrectomy (RAPN) was the most common approach (63.4%) and had the lowest odds of complications and mortality compared to open surgery.

Laparoscopic partial nephrectomy (LAPN) had the lowest median hospital costs ($14,627) and lower complication rates than open surgery.

RAPN and LAPN showed clinical advantages over open partial nephrectomy (OPN), including shorter hospital stays and fewer transfusions.

Abstract

Partial nephrectomy is increasingly favored for small renal masses due to its renal function-preserving benefits. This study compared contemporary utilization patterns, perioperative outcomes, and hospital costs of robotic-assisted (RAPN), laparoscopic (LAPN), and open partial nephrectomy (OPN) among U.S. patients with renal cancer.

Using the 2016–2019 National Inpatient Sample, renal cancer patients undergoing RAPN, LAPN, or OPN based on ICD-10-CM/PCS codes were identified. Patient demographics, comorbidities, hospital characteristics, length of stay (LOS), perioperative complications, and hospital costs, were summarized by surgical approach. Regression analyses adjusted for patient- and hospital-level covariates were used to compare perioperative outcomes, LOS, and costs across procedures.

An estimated 89,290 partial nephrectomies were identified (mean age 59.4 years; 60.4% male; 68.9% white). RAPN was the most common approach (63.4%), followed by OPN (22.6%) and LAPN (14.0%). Median hospital costs were lowest for LAPN ($14,627), compared with RAPN ($15,187) and OPN ($15,364). Both RAPN and LAPN were associated with lower odds of perioperative complications compared with OPN (RAPN: OR 0.48, 95% CI 0.43–0.55; LAPN: OR 0.51, 95% CI 0.43–0.61). RAPN was additionally associated with lower odds of blood transfusion, in-hospital mortality, and shorter LOS. After adjustment, hospital costs for RAPN and LAPN were not statistically significantly different from those for OPN.

RAPN represents the predominant minimally invasive approach for partial nephrectomy in contemporary U.S. practice. Minimally invasive techniques offer clear clinical advantages over open surgery, with RAPN demonstrating more favorable intraoperative outcomes than LAPN. Future research should assess long-term functional, oncologic, and economic outcomes.

The online version contains supplementary material available at 10.1007/s00345-026-06329-w.