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[80] These data suggest that for PN for SRM, the large capital costs of RAPN are offset by decreased postoperative hospitalization costs and decreased disposable equipment costs, and might result in cost equivalency with LPN and OPN. It could be, too, that there are long-term economic advantages to the expansion of NSS. It is likely that the prevention of CKD and cardiovascular morbidity will have associated cost advantages. Initially, Roger et?al. and Patel et?al. described their experiences for RAPN to treat complex renal tumors including hilar, endophytic, multiple and ��4?cm tumors.[26-28] The investigators concluded that RAPN is a safe and feasible approach for select patients with complex renal tumors. Clinical outcomes are difficult to interpret in settings of significant selection bias and lack of stratification by anatomical complexity.[23] http://www.selleckchem.com/products/rxdx-106-cep-40783.html In 2009, Kutikov and Uzzo described the R.E.N.A.L. nephrometry score (RN score), a novel system to quantify anatomical elements of renal complexity.[81] The nephrometry scoring system was determined by five reproducible and important features that characterize the renal tumor anatomical attributes as they apply to surgical http://www.selleckchem.com/products/CP-673451.html respectability, including the radius (tumor size), exophytic or endophytic (location and depth), nearness to the renal sinus fat or collecting system, anterior or posterior position, and location (polar vs non-polar). The RN score can be helpful in evaluating the anatomical complexity of renal masses, and being associated with intraoperative parameters, such as ischemia time, EBL and LOS, in patients https://en.wikipedia.org/wiki/Crotamiton undergoing PN.[81-83] The RN score was also able to predict the risk of postoperative complications stratified by Clavien classification in patients undergoing PN.[83] Like the RN score, the PADUA score was another system for characterizing the complexity of renal masses and was a predictor of complications for patients undergoing NSS.[83-85] Currently, many centers have shown the safety and feasibility of RAPN for more complex cases classified by RN score.[36, 41, 44-46] A recent multi-institution study evaluated RPN for tumors >4?cm.[46] Patients with tumors >4?cm had a higher RN score, longer WIT, higher operative times and slightly higher EBL compared with patients who had tumors ��4?cm. Although the results were statistically significant, there was no increased risk of adverse outcomes in the hands of experienced surgeons. Additionally, it was reported by the same analysis of RAPN for renal hilar tumors. The only significant difference in operative outcomes was an increased WIT for the hilar group vs the non-hilar group (26.3?��?7.4?min vs 19.6?��?10.0?min; P?=?