Robotic Versus Laparoscopic Cholecystectomy Inpatient Analysis: Does the End Justify the Means?

Kamiński, Jan P.; Bueltmann, Kenneth W.; Rudnicki, Marek

doi:10.1007/s11605-014-2673-3

Cited by 27 publications

(21 citation statements)

References 30 publications

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“…Current average cost for robotic instruments and accessories used during major pancreatic resection adds $2,007 to operative costs, an estimate significantly lower than $3,330 as reported by Butturini et al (31). Further, a link between cost and case experience has been observed consistent with a learning curve effect; robotic surgery costs decreased 14.6% between 2011 ($23,595) and 2010 ($19,528) while laparoscopic costs remained stable ($15,286 and $15,195) (43).…”

Section: The Coming Renaissancementioning

confidence: 77%

“…A large population-based study conducted by Kamiński et al examined differences in surgical outcomes and cost between robotic and laparoscopic cholecystectomies using 2010 and 2011 data from the National Inpatient Sample Health Cost Utilization Project (43). While length of stay and complication rates were similar, total hospital costs in the robotic group ranged from $4,333 to $8,310 higher than the laparoscopic group, despite excluding amortization costs for the robotic system.…”

Section: Rcmentioning

confidence: 99%

“…Four analyzed direct hospital costs (42-45) while one measured top-down costs (46) and one measured instrument costs (19). Two of the four hospital cost analyses demonstrated increased hospital costs of at least $1,900 (42,43). The top down analysis found a minimum additional cost of $2,600 per procedure (43) while the instrument price examination found equal instrument costs (19).…”

Section: Analysis Of Rcmentioning

confidence: 99%

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Value-based assessment of robotic pancreas and liver surgery

Patti

Ore

Barrows

et al. 2017

Hepatobiliary Surg. Nutr.

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Current healthcare economic evaluations are based only on the perspective of a single stakeholder to the healthcare delivery process. A true value-based decision incorporates all of the outcomes that could be impacted by a single episode of surgical care. We define the value proposition for robotic surgery using a stakeholder model incorporating the interests of all groups participating in the provision of healthcare services: patients, surgeons, hospitals and payers. One of the developing and expanding fields that could benefit the most from a complete value-based analysis is robotic hepatopancreaticobiliary (HPB) surgery. While initial robot purchasing costs are high, the benefits over laparoscopic surgery are considerable. Performing a literature search we found a total of 18 economic evaluations for robotic HPB surgery. We found a lack of evaluations that were carried out from a perspective that incorporates all of the impacts of a single episode of surgical care and that included a comprehensive hospital cost assessment. For distal pancreatectomies, the two most thorough examinations came to conflicting results regarding total cost savings compared to laparoscopic approaches. The most thorough pancreaticoduodenectomy evaluation found non-significant savings for total hospital costs. Robotic hepatectomies showed no cost savings over laparoscopic and only modest savings over open techniques. Lastly, robotic cholecystectomies were found to be more expensive than the gold-standard laparoscopic approach. Existing cost accounting data associated with robotic HPB surgery is incomplete and unlikely to reflect the state of this field in the future. Current data combines the learning curves for new surgical procedures being undertaken by HPB surgeons with costs derived from a market dominated by a single supplier of robotic instruments. As a result, the value proposition for stakeholders in this process cannot be defined. In order to solve this problem, future studies must incorporate (I) quality of life, survival, and return to independent function alongside data such as (II) intent-to-treat analysis of minimally-invasive surgery accounting for conversions to open, (III) surgeon and institution experience and operative time as surrogates for the learning curve; and (IV) amortization and maintenance costs as well as direct costs of disposables and instruments.

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Section: The Coming Renaissancementioning

confidence: 77%

Section: Rcmentioning

confidence: 99%

Section: Analysis Of Rcmentioning

confidence: 99%

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Value-based assessment of robotic pancreas and liver surgery

Patti

Ore

Barrows

et al. 2017

Hepatobiliary Surg. Nutr.

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“…Data on robotic surgeries cost and clinical outcomes are procedure-specific; therefore, robotassisted outcomes have not shown consistent benefits, whereas other authors support robotassisted over standard laparoscopy for cholecystectomies [4]. Salman et al reviewed a national database and showed that robotic surgery had significantly shorter lengths of stay than open surgery and had lower charges than laparoscopic and open surgery [7].…”

Section: Discussionmentioning

confidence: 99%

“…There was less emphasis on other aspects of the clinical outcomes. Certain robotic procedures have already been shown to have better operative outcomes compared with open surgery in terms of length of hospital stay (LOS), complications and mortality, yet many studies comparing laparoscopic with robot-assisted surgeries have produced conflicting results in terms of clinical outcomes and cost-effectiveness [3][4][5][6]. Cholecystectomy is one of the most common procedures where the robot-assisted approach has been used.…”

Section: Introductionmentioning

confidence: 99%

Robotic versus Laparoscopic Cholecystectomy: Case-Control Outcome Analysis and Surgical Resident Training Implications

Ghanem

Shaheen

Blebea

et al. 2020

Cureus

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Description of robotic single site cholecystectomy and a review of outcomes

Dominguez

Hernandez-Murcia

Gonzalez

2015

Journal of Surgical Oncology

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New technologies have been developed to make laparoscopic cholecystectomy less invasive through single incision laparoscopic surgery (SILS), however this approach has its own limitations. Single incision robotic surgery (SIRC) is designed to overcome them. The concerns that limit adoption of this technology are attributed increases in costs, prolonged learning curves and surgical times. Here, we provide a literature review as well as our own experience with SIRC, with the intent to clarify these important concerns.

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Robotic Versus Laparoscopic Cholecystectomy Inpatient Analysis: Does the End Justify the Means?

Abstract: LOS of RAC is similar to LC. Cost of RAC remains higher compared to LC although there was reduction in cost of RAC in 2011 versus 2010.

Cited by 27 publications

References 30 publications

Value-based assessment of robotic pancreas and liver surgery

Value-based assessment of robotic pancreas and liver surgery

Robotic versus Laparoscopic Cholecystectomy: Case-Control Outcome Analysis and Surgical Resident Training Implications

Description of robotic single site cholecystectomy and a review of outcomes

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