Defining the Cost of Care for Lobectomy and Segmentectomy: A Comparison of Open, Video-Assisted Thoracoscopic, and Robotic Approaches

Deen, Shaun A.; Wilson, Jennifer; Wilshire, Candice L.; Vallières, Eric; Farivar, Alexander S.; Aye, Ralph W.; Ely, Robson E.; Louie, Brian E.

doi:10.1016/j.athoracsur.2013.11.021

Cited by 123 publications

(116 citation statements)

References 9 publications

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“…The authors believe that robotic technology favors a more radical resection in the case of complex locally advanced tumours. Robotic technology has some limitations that have affected adoption such as significant capital and maintenance costs (35,36), reduced operating room efficiencies, and a steep learning curve (37). For these reasons, the integration of the robotic platform into the management of complex locally advanced disease should be measured and only implemented after proven success on an adequate number of standard lobectomies before approaching more complex situation such as lobectomy after chemotherapy or lobectomy for N2 disease (38).…”

Section: Discussionmentioning

confidence: 99%

Robotic assisted lobectomy for locally advanced lung cancer

et al. 2017

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Some series report the use of video-assisted thoracic surgery (VATS) in patients with locally advanced non-small cell lung cancer (NSCLC) but, few studies describe the use of the robotic approach specifically for locally advanced disease. One potential advantage of the robotic approach over traditional VATS is the increased radicality. While the benefit of the robotic approach over open thoracotomy is directly related to reduced surgical trauma and the improved tolerability in fragile patients that have received induction treatment. In case of occult N2 disease, robotic assisted surgery can translate into a quicker recovery with improved compliance with adjuvant treatments following surgery. Technical details are reported and described. The robotic instrument technology allows sharp and controlled dissection compared to the typical blunt sweeping methods used in most VATS lobectomy techniques. The authors believe that robotic technology favors a more radical resection in the case of complex locally advanced tumors. Robotic technology has some limitations that have affected adoption such as significant capital and maintenance costs, reduced operating room efficiencies, and a steep learning curve.

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Section: Discussionmentioning

confidence: 99%

Robotic assisted lobectomy for locally advanced lung cancer

et al. 2017

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“…Deen et al (31) analyzed 184 consecutive patients with similar comorbidities who underwent lobectomy or segmentectomy (69 by thoracotomy, 57 by robot, and 58 by VATS). There were no differences in complication rate or length of hospital stay, but significantly different operation times.…”

Section: Costs Of Robotic Surgery For Lung Cancermentioning

confidence: 99%

Robotic lung cancer surgery: review of experience and costs

et al. 2017

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Use of robot-assisted techniques is growing fast in several surgical disciplines, now including thoracic surgery. The paper reviews experience of robotic surgery to resect lung cancer and in particular analyzes data on the costs of these procedures in comparison to open surgery and video-assisted thoracoscopic surgery (VATS). Retrospective studies published over 14 years show that robotic surgery for lung cancer has the advantages of minimally invasive surgery for patients, and some advantages over VATS for the surgeon. Limited data indicate that oncological outcomes are comparable with those of VATS and open surgery, while lymph node dissection may be more radical. Other studies indicate that robotic surgery for lung cancer offers no advantages either in terms of costs or outcomes. The high costs of purchase, maintenance and consumables are a concern and continue to limit uptake of robot systems in thoracic surgery. Most studies-but not all-indicate that robotic surgery for lung cancer is more expensive than VATS and open surgery. However limited data also indicate that hospitals can make a profit from robotic thoracic surgery, as costs seem to be lower than reimbursements from paying bodies. Nevertheless robotic thoracic surgery is still too expensive for many public hospitals, particularly in low income countries. Entry of new surgical robot manufacturers onto the market will bring much-needed competition that may also lead to cost reduction.

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“…In many countries in which medical services are covered by health insurance, the increase in medical costs induced by robot surgery aims at the ultimate decrease in medical costs by shortening the length of hospitalization and reducing postoperative complications. It seems that decisions on the medical system of robotic surgery in the future require comprehensive investigations incorporating an overall view and comprehension of the medical system as a single integrated whole concept, [1][2][3][4][5][6] and it is essential for future stable development that the problem should be settled as soon as possible. It seems that the economic management in the unit institution is enabled if the dVS would be utilized in combination with urology, gynecology, and gastrointestinal surgery under the present Japanese conditions, that is, as shown in Figs.…”

Section: Discussionmentioning

confidence: 99%

“…Subsequently, robot-assisted partial nephrectomy (RAPN) for small renal cell carcinomas (cT1N0M0) has also become eligible for reimbursement by the JNHIS since April 2016. According to several investigations of cost-effectiveness in countries outside Japan, robot-assisted thoracic surgery (RATS) has a financial deficit from the point of view of health economics in comparison with VATS, [1][2][3][4][5][6] despite differences in the medical health insurance systems. Other clinical fields are still waiting for reimbursement for the da Vinci Surgical System (dVS) operations, for example, gastrectomy, uterectomy, and thymectomy.…”

Section: Introductionmentioning

confidence: 99%

Cost-Benefit Performance Simulation of Robot-Assisted Thoracic Surgery As Required for Financial Viability under the 2016 Revised Reimbursement Paradigm of the Japanese National Health Insurance System

Kajiwara

Kato

Hagiwara

et al. 2018

ATCS

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Purpose: To discuss the cost-benefit performance (CBP) and establish a medical fee system for robotic-assisted thoracic surgery (RATS) under the Japanese National Health Insurance System (JNHIS), which is a system not yet firmly established. Conclusion: Robotic surgery in some areas receives insurance reimbursement for its "supportive" use for endoscopic surgery as for RALP and RAPN. However, at present, it is necessary to perform da Vinci Surgical System Si (dVSi) surgery at least 150-300 times in a year in a given institution to prevent a deficit in income.

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Defining the Cost of Care for Lobectomy and Segmentectomy: A Comparison of Open, Video-Assisted Thoracoscopic, and Robotic Approaches

Cited by 123 publications

References 9 publications

Robotic assisted lobectomy for locally advanced lung cancer

Robotic assisted lobectomy for locally advanced lung cancer

Robotic lung cancer surgery: review of experience and costs

Cost-Benefit Performance Simulation of Robot-Assisted Thoracic Surgery As Required for Financial Viability under the 2016 Revised Reimbursement Paradigm of the Japanese National Health Insurance System

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