iRobot.

Radical nephrectomy remains the standard of care for all but the very smallest (4 cm or less) renal cell carcinomas (RCC). Compared to open radical nephrectomies, newer less invasive alternatives promise quicker recoveries without forfeiting oncologic outcomes. But how does the sexier robotically-assisted approach stack up to the more tried and true laparoscopy? According to this week’s JAMA pub, over a quarter of all radical nephrectomies are now done robotically—a dramatic increase from a mere 1.5% little more than a decade ago—despite no solid evidence to support its superiority in the face of solid increased costs. Among this cohort of >23K patients undergoing RCC resections, robotic versus laparoscopic technology resulted in no improvements among any level of postoperative complications. What did it result in? Longer times in the operating room translating to significantly increased expenditures. Simultaneous reporting of the randomized ROLARR trial of robotic versus laparoscopic rectal cancer resections also failed to show improvement with the former, more expensive, modality. It appears the current robot takeover of oncologic resections is far from data-driven, so perhaps it’s time to Roomba all this waste.