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Growth in robotic-assisted procedures is from conversion of laparoscopic procedures and not from open surgeons’ conversion: a study of trends and costs

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Abstract

Background

Utilization of laparoscopy (LAP) has been increasing in general surgery for years, and there is currently a rapid increase in the utilization of robotic-assisted surgeries (RAS). This study evaluates trends in the surgical approach utilized in some commonly performed surgeries, the proportion of each approach within the procedures, and the cost of these surgeries based on the surgical approach.

Methods

This is a retrospective study using the Vizient database. The database was queried using ICD-9 codes for colectomy, cholecystectomy, inguinal and ventral hernia repairs, and bariatric surgeries, either open, LAP, or robotically performed. Utilization trends were evaluated between quarters, over a 7-year period, and direct cost was compared between approaches. IBM SPSS v.23.0.0 was used for data analysis, with α = 0.05.

Results

857,468 patients underwent colectomy, cholecystectomy, inguinal and ventral hernia repairs, and bariatric procedures. A significant decrease in open-approach utilization was seen in colectomy (71.8–61.9%), cholecystectomy (35.7–27.1%), and bariatric surgeries (20.1–10.1%), whereas both LAP and RAS utilization increased (p < 0.001). Significant RAS increase was seen in all five procedures: colectomy (0.4–8.0%), cholecystectomy (0.2–1.8%), IHR (19.9–29.4%), VHR (0.2–2.9%), and bariatric (0.6–5.4%), compared to a decrease in LAP (p < 0.001). Surgery cost was significantly higher for open ($14,364), followed by RAS ($11,376) and LAP ($7945), p < 0.001.

Conclusions

Robotic technology is commonly viewed as enabling open procedures to be converted to minimally invasive, a trend not observed in our study. Our trends analysis revealed significant RAS utilization increase from LAP procedures and not from open procedure conversion, although specific surgeon data were not available. RAS were costlier than LAP for all five procedures. The benefits of rapid robot adoption and the forces that are driving these must be examined against a backdrop of burdening an already expensive healthcare system.

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Funding

Funding for this study was provided by the Center for Advanced Surgical Technology at the University of Nebraska Medical Center and the Foundation for Surgical Fellows.

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Authors and Affiliations

  1. Center for Advanced Surgical Technology, University of Nebraska Medical Center, 986245 Nebraska Medical Center, Omaha, NE, 68198-6246, USA

    Priscila R. Armijo, Tiffany Tanner & Dmitry Oleynikov

  2. Department of Surgery, University of Nebraska Medical Center, 986245 Nebraska Medical Center, Omaha, NE, 68198-6246, USA

    Spyridon Pagkratis, Tiffany Tanner & Dmitry Oleynikov

  3. College of Public Health, University of Nebraska Medical Center, 984355 Nebraska Medical Center, Omaha, NE, 68198-4355, USA

    Eugene Boilesen

Authors
  1. Priscila R. Armijo
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  2. Spyridon Pagkratis
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  3. Eugene Boilesen
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  4. Tiffany Tanner
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  5. Dmitry Oleynikov
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Corresponding author

Correspondence to Dmitry Oleynikov.

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Disclosure

Dmitry Oleynikov is the Stock Holder of Virtual Incision Corporation. Priscila R. Armijo, Spyridon Pagkratis, Eugene Boilesen, and Tiffany Tanner have nothing to disclose.

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Armijo, P.R., Pagkratis, S., Boilesen, E. et al. Growth in robotic-assisted procedures is from conversion of laparoscopic procedures and not from open surgeons’ conversion: a study of trends and costs. Surg Endosc 32, 2106–2113 (2018). https://doi.org/10.1007/s00464-017-5908-z

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  • DOI: https://doi.org/10.1007/s00464-017-5908-z

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