Cost effectiveness and robot-assisted urologic surgery: does it make dollars and sense?

Dobbs, Ryan W.; Magnan, Brenden; Abhyankar, Nikita; Hemal, Ashok K.; Challacombe, Benjamin; Hu, Jim; Porpiglia, Francesco; Crivellaro, Simone

doi:10.23736/s0393-2249.16.02866-6

Cited by 24 publications

(8 citation statements)

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“…Since its initial approval in 2000 by the United States Food and Drug Administration (FDA), the da Vinci surgical robot (Intuitive Surgical Inc. Sunnyvale, CA) has been rapidly adopted by urologists for performing radical prostatectomy (RP) [ 1 ]. Between 2003 and 2013, the proportion of Robot-Assisted Radical Prostatectomy (RARP) rose from 1.8 to 85%[ 2 ] and since the release of the initial da Vinci standard (S) model, there have been several iterations of this platform released including the Si (2009), Xi (2014) and single-port (SP) (2018) systems.…”

Section: Introductionmentioning

confidence: 99%

Radical prostatectomy technique in the robotic evolution: from da Vinci standard to single port—a single surgeon pathway

et al. 2021

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To describe perioperative outcomes following robot-assisted prostatectomy performed by a single surgeon during transitions between da Vinci standard/Si/Xi and the single port. Perioperative data were retrospectively evaluated of the first 40 consecutive robot-assisted radical prostatectomies performed by a single surgeon using the da Vinci standard, Si, Xi and single port. A total of 160 patients were included. We matched standard vs Si (Match 1), Si vs Xi (Match 2) and Xi vs single port (Match 3) cohort. Mann–Whitney and Fisher’s tests were used to test the difference among the groups. Univariate and multivariate logistic regression analyses were adopted to evaluate the predictors of overall and major complications. Single-port procedures in Match 3 showed significant shorter median operative time than Xi. Both Si and single-port groups showed significantly less median blood loss, a shorter median length of stay, respectively, than standard group in Match 1 and than Xi group in Match 3. 1 standard group patient required conversion to open surgery for an unsolvable conflict of the robotic arms. No other intraoperative complications were noted. On univariate and multivariate analyses, the da Vinci platform model was not a predicting factor of major complications (Clavien–Dindo ≥ 3). We described how technological progress impacted peri and postoperative outcomes during transitions between robotic surgical platforms for radical prostatectomy. In particular, the technological improvements associated to the increased surgeon’s expertise made the transition to the single port safe and effective when compared with previous platforms.

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Section: Introductionmentioning

confidence: 99%

Radical prostatectomy technique in the robotic evolution: from da Vinci standard to single port—a single surgeon pathway

et al. 2021

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“…Nevertheless, in other respects, TMLUR has certain advantages over RALUR for DUS in children. Primarily, robotic surgery has been criticized for the prohibitive cost of the platform and disposable instruments [ 27 ], which may increase expenditure for patients. Consistently, we found higher hospitalization expenses of the RALUR group in this study.…”

Section: Discussionmentioning

confidence: 99%

Robot-Assisted versus Trans-Umbilical Multiport Laparoscopic Ureteral Reimplantation for Pediatric Benign Distal Ureteral Stricture: Mid-Term Results at a Single Center

Guo

Yang

et al. 2022

JCM

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Objective: Robot-assisted laparoscopic ureteral reimplantation (RALUR) and trans-umbilical multiport laparoscopic ureteral reimplantation (TMLUR) are both minimally invasive procedures for benign distal ureteral stricture (DUS). However, TMLUR has rarely been reported in published research, thus the difference in mid-term outcome of these two procedures warrants investigation. Methods: Patients who underwent RALUR or TMLUR for pediatric DUS from April 2017 to November 2020 at our institution were retrospectively analyzed and 56 patients were included in this retrospective comparison. Demographic characteristics, perioperative data and follow-up results were collected and analyzed in RALUR and TALUR groups. Results: RALUR and TMLUR were successfully performed in children aged from 12.0 to 142.0 months, without conversion to open ureteral reimplantation. RALUR took shorter operative time than TMLUR (p = 0.005) with less blood loss (p = 0.001). Meanwhile, patients receiving RALUR encountered a greater financial burden (p < 0.001) with less cosmetic satisfaction than TMLUR. The mean mid-term follow-up time for RALUR and TMLUR was 18.29 months and 24.64 months, respectively. Mid-term follow-up data showed that DUS was relieved with improved renal function after surgery in both groups, with no significant difference. Conclusions: RALUR and TMLUR are both safe and efficient for DUS treatment and achieve comparable mid-term outcomes in children. RALUR can reduce operative time and operative blood loss benefiting from its prominent technical superiority, but may currently bring about greater financial burden, with cosmetic satisfaction remaining to be improved.

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“…This shift from traditional laparoscopy toward the da Vinci ™ system has been reflected in trainee experience. Yet, detractors point out that the benefits of robot -assisted urologic surgery have oftentimes been overstated or a tradeoff with unique downsides, specifically in the pediatric arena (7,8).. With an increasing sensitivity toward surgical costs, some have questioned the value of this technology's adoption (9,10). As with any new surgical technology, the urologic community is learning what operative goals are best approached with robot-assistance.…”

Section: Introductionmentioning

confidence: 99%

Robot-assisted laparoscopic orchiopexy: A comparative analysis with laparoscopic orchiopexy

et al. 2023

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BackgroundWhile undescended testes are relatively common, the nonpalpable testis remains a challenging problem. The gold standard treatment remains the laparoscopic orchiopexy. However, today robot-assisted surgery has challenged traditional laparoscopy in many areas of urology. Yet the value of this new approach remains controversial, given concerns with operative time and cost. We reviewed our contemporary results of both robot-assisted orchiopexy (RALO) and traditional laparoscopic orchiopexy (TLO). Our primary aims were to retrospectively compare success rates, and operative time. Our secondary aims were to compare costs and complications related to each method.MethodsIn this study, all patients treated with laparoscopic and robot-assisted laparoscopic orchiopexy from April 2017 to January 2022 were reviewed using CPT code 54692. Exclusion criteria included bilateral concomitant orchiopexy or concomitant “major surgery,” or follow up less than 6 months. Also excluded were 1st stage orchiopexies. For the purposes of comparison, 1-stage and 2nd stage orchiopexies were included in the analysis. Patient demographics, surgical operative notes and documentation were all reviewed.ResultsAfter exclusion criteria was applied, 16 and 17 remained in the laparoscopic and robot-assisted cohorts, respectively. Upon follow up, all patients in both the laparoscopic and robot-assisted cohorts were noted to have a healthy testicle palpable in the dependent portion of the scrotum. The median operative time in the TLO group was 71 minutes, compared to 101 minutes in the RALO group (p>0.0001). When comparing median hospital charges, the TLO group was lower at $38,813, compared to $46,455 in the RALO group (p = 0.0069). There was one postoperative complication in the TLO group (localized wound infection), compared to zero in the RALO group.ConclusionsThe robot-assisted orchiopexy is safe and effective. However, at this time it remains more costly in terms of time and resources.

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Cost effectiveness and robot-assisted urologic surgery: does it make dollars and sense?

Cited by 24 publications

References 0 publications

Radical prostatectomy technique in the robotic evolution: from da Vinci standard to single port—a single surgeon pathway

Radical prostatectomy technique in the robotic evolution: from da Vinci standard to single port—a single surgeon pathway

Robot-Assisted versus Trans-Umbilical Multiport Laparoscopic Ureteral Reimplantation for Pediatric Benign Distal Ureteral Stricture: Mid-Term Results at a Single Center

Robot-assisted laparoscopic orchiopexy: A comparative analysis with laparoscopic orchiopexy

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