Background: One of the perceived major drawbacks of minimally invasive techniques has always been its cost. This is especially true for the robotic approach and is one of the main reasons that has prevented its wider acceptance among hospitals and surgeons. The aim of our study was to evaluate the clinical outcomes and economic impact of robotic and open liver surgery in a single institution.Methods: Sixty-eight robotic and 55 open hepatectomies were performed at our institution between January 1, 2009 and December 31, 2013. Demographics, perioperative data, and postoperative outcomes were collected and compared between the two groups. An independent company performed the financial analysis. The economic parameters comprised direct variable costs, direct fixed costs, and indirect costs.Results: Mean estimated blood loss was significantly less in the robotic group (438 versus 727.8 mL; P = .038). Overall morbidity was significantly lower in the robotic group (22% versus 40%; P = .047). Clavien III/IV complications were also lower, with 4.4% in the robotic versus 16.3% in the open group (P = .043). The length of stay in the intensive care unit (ICU) was shorter for patients who underwent a robotic procedure (2.1 versus 3.3 days; P = .004). The average total cost, including readmissions, was $37,518 for robotic surgery and $41,948 for open technique.Conclusions: Robotic liver resections had less overall morbidity, ICU, and hospital stay. This translates into decreased average costs for robotic surgery. These procedures are financially comparable to open resections and do not represent a financial burden to the hospital.

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Aim: The purpose of this study was to evaluate presurgical comorbidities, perioperative and postoperative complications, and postsurgical outcomes of minimally invasive bariatric surgery in patients aged 55 years and older to determine if age should be used as a selection criteria for bariatric surgery. Methods: A total of 750 patients underwent sleeve gastrectomy or robotic-assisted Roux-en-Y gastric bypass from January 2008 to June 2014. Patients were divided into three groups according to age: <55 years old; ‡55 to <65 years old; and ‡65 years old. Demographics, presurgical comorbidities, perioperative and postoperative complications (leaks or conversions to open surgery), and postsurgical outcomes were compared across the different groups. Results: Significant differences in presurgical comorbidities were found across age groups ( p < 0.001). Results from descriptive statistics revealed that patients younger than 55 years of age had a greater number of complications-defined as leaks (n = 1) or conversions to open surgery (n = 2)-than did patients older than 55 years of age. There were no significant differences across age groups regarding length of stay. Linear regression analysis failed to reveal significant associations between age and percentage excess weight loss at 6, 12, and 24 months follow-up. Conclusions: These initial results suggest that patient selection for bariatric surgery should not be based on age alone.

There is no significant difference between the robotic and laparoscopic group in terms of complications, length of stay, and estimated blood loss. Robot-assisted sleeve gastrectomy is associated with longer operative time and increased cost.