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The second concern is the recurrence rate. The first reported series of RAPN came out only a few years ago. It is too early to assess recurrence rates. In a recent review, Shapiro et?al. reported excellent oncological outcomes of the initial experience with RAPN, which parallel those reported in LPN series.[75] In 100 RAPN procedures, Scoll et?al. found no recurrence at a median 12 months follow up.[34] In another series, authors extensively monitored the patients in their case series that had PSM and found no tumor recurrence at a median 16-month follow up.[39] There are several recent reports showing low recurrence rates after PN (0�C10%), and even lower rates (1�C3%) when carrying out PN for tumors ( https://en.wikipedia.org/wiki/Crotamiton control.[76, 77] Hospital stay is an important consideration that can sway a patient's treatment option decision, if all other variables are equal. The mean LOS of two minimal-invasive groups were shorter than the OPN group, respectively, but the difference compared with that of RAPN and LPN is controversial. A multi-institutional analysis suggested the LOS was significantly shorter for RAPN (2.4 days) when compared with LPN (2.7 days),[39] but this was not statistically http://www.selleckchem.com/products/rxdx-106-cep-40783.html significant. Considering that the mean hospital stay for RAPN in the landmark study by Gettman et?al. was 4.3 days, the decreasing LOS suggests the improvements with RAPN and postoperative care continue over time.[31] In fact, compared with initial experiences, Kaouk et?al. showed significantly shorter LOS in the contemporary experience of RAPN.[36] Similarly, our series showed an average length of hospital stay of 2.5 days compared with 3.7 days with the LPN cohort. Critics of robot-assisted surgery often cite high capital expenses and reusable equipment costs associated with this approach. Robotic-assisted laparoscopic surgery is more costly than laparoscopic and open surgery.[78] Interestingly, RAPN seems to be an exception. Ferguson et?al. undertook a direct-cost analysis in clinically similar groups of patients and tumors.[79] No difference in total cost was shown between RAPN and LPN ($13?560 vs $13?439, P?=?0.29). http://www.selleckchem.com/products/CP-673451.html OR costs were higher for RAPN ($7276 vs $5708, P?=?0.0001) because of the higher robotic capital and reusable equipment costs that outweighed higher disposable costs in the LPN group. OR time-related costs were similar between groups. RAPN patients had a shorter LOS, which decreased postoperative hospital costs ($4371 vs $5984, P?=?0.002). Data from Yu et?al. showed healthcare costs were higher for robotic vs laparoscopic and open surgery for three procedures (including radical prostatectomy, pyeloplasty, RN), except for PN, where costs were similar.