Abstract
BACKGROUND: Minimally invasive approaches, including laparoscopic (LARN) and robotic-assisted radical nephrectomy (RARN), have gained adoption over open surgery (ORN) for renal cancer, despite RARN’s higher costs. This contemporary study evaluates trends in RARN, LARN, and ORN use and compares their hospital costs, clinical complications, and mortality rates. METHODS: Patients undergoing radical nephrectomy (2016–2019) were identified from the National Inpatient Sample (NIS). Procedures were classified as RARN, LARN, or ORN using ICD-10 and Procedure Coding System codes. Patient demographics and comorbidities, hospital characteristics, length of stay (LOS), clinical complications, and hospital costs were analyzed. Trends in utilization were assessed, and regression models adjusted for patient and hospital factors examined associations between surgical approach and inpatient perioperative outcomes, including complications, mortality, LOS, and hospital costs. RESULTS: Among 154,115 patients, 39.5% underwent LARN, 25.7% RARN, and 34.8% ORN. Annual RARN utilization increased (21.8% to 29.6%), while LARN declined (44.8% to 35.2%). RARN was more common in older and comorbid patients. Median costs were lowest for LARN ($13,950) compared to RARN ($16,771) and ORN ($17,821). Both RARN and LARN had lower inpatient perioperative complications, blood transfusion rates, and mortality than ORN. RARN and LARN were associated with reduced LOS and costs relative to ORN. While RARN was 15% more expensive than LARN, it had 5% shorter LOS. A limitation was the absence of tumor characteristic data. CONCLUSIONS: RARN and LARN are increasingly used and both demonstrated better inpatient perioperative outcomes than ORN. However, RARN offers no clear clinical advantage over LARN and remains more costly than LARN. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1007/s11701-025-02995-x.