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Comment & Response
March 20, 2018

Robotic-Assisted vs Laparoscopic Radical Nephrectomy—Reply

Author Affiliations
  • 1Department of Urology, Asan Medical Center, Seoul, Korea
  • 2Department of Urology, Stanford University Medical Center, Stanford, California
JAMA. 2018;319(11):1166. doi:10.1001/jama.2017.21876

In Reply Dr Weiner and colleagues suggest that a significant portion of robotic-assisted radical nephrectomies in our study may actually be unsuccessful partial nephrectomies that resulted in conversion to radical nephrectomies. The authors cited a prior study by our group that used the same data set but different methodology.1 This latter study incorporated hospital-specific projection weighting provided by Premier that allowed the results to be extrapolated to a national sample of inpatient discharges. This additional weighting likely increased the sample of converted partial nephrectomies by 500% to 600%. In contrast, due to journal preference, projection weights were not included in our current study. Additionally, the inclusion criteria in the studies differed: the prior study excluded patients not receiving intraoperative mannitol. Thus, a direct comparison between the 2 studies, including the requested sensitivity analysis, is not feasible.