Financial Impact of the Robotic Approach in Liver Surgery: A Comparative Study of Clinical Outcomes and Costs Between the Robotic and Open Technique in a Single Institution

Abstract

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.

Comparative Study of the Initial Experience in Performing Robotic and Laparoscopic Right Hepatectomy with Technical Description of the Robotic Technique

“…Considering the high cost of purchasing and installing, and the yearly cost of maintenance (USD 2,200,000 and 150,000 respectively), it is evident that only high volume centers can employ this technology. However, when compared to open liver surgery, Daskalaki et al [33] demonstrated lower total cost, including readmissions, for robotic liver procedures (USD 41,948 vs. 37,518) along with significantly lower estimated blood loss, overall morbidity, and Clavien III/ IV complication rate. Nevertheless, according to Salloum et al [34], when considering the cost of purchasing a robotic platform installation (USD 2,200,000) and the annual cost of maintenance (USD 150,000 per year), robotic liver procedures appear to be much more expensive than conventional laparoscopic surgeries.…”

Robotic liver resection for hepatocellular carcinoma: A systematic review

“…Similarly, a study from the University of Illinois at Chicago demonstrated that postoperative outcomes after robotic liver procedures are related to lower rates of postoperative morbidity compared with the open approach group, including conversion to open (22% versus 40%; P = .047). Therefore, they concluded that robotic approach is not really a financial burden for hospitals . Conversely, Yu et al reported in their work comparing robotic and laparoscopic liver resections that the total medical cost was significantly higher in the robotic group (robot vs lap; $11.475 ± 2174 vs $6762 ± 1436, P = .001) .…”

Robot-Assisted Transplant Surgery - Vision or Reality A Comprehensive Review

“…While the operative time in live donor right hepatectomy is significantly longer compared with open procedures, there is no difference in complication rates, blood loss, and postoperative function of the liver remnant [2,45]. Decreased overall morbidity and intensive care unit and hospital stay are in favor of laparoscopic procedures while the operation per se adds tremendously to treatment cost, especially in the case of robotic systems being used.…”

“…Decreased overall morbidity and intensive care unit and hospital stay are in favor of laparoscopic procedures while the operation per se adds tremendously to treatment cost, especially in the case of robotic systems being used. Taking into consideration the higher costs as well as the longer operating time, robotic-assisted donor right hepatectomy is not advantageous over conventional laparoscopic approaches [45].…”