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Cost analysis of robotic assisted general surgery cases in a single academic institution

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Abstract

Laparoscopy is currently the standard approach for minimally invasive general surgery procedures. However, robotic surgery is now increasingly being used in general surgery. Robotic surgery provides several advantages such as 3D-visualization, articulated instruments, improved ergonomics, and increased dexterity, but is also associated with an increased overall cost which limits its widespread use. In our institution, the robotic assisted approach is frequently used for the performance of general surgery cases including inguinal hernias, cholecystectomies and paraesophageal hernia (PEH) repairs. The primary aim of the study was to evaluate the differences in cost between a robotic and laparoscopic approach for the above-mentioned cases. With IRB approval, we conducted a retrospective cost analysis of patients undergoing inguinal hernia repairs, cholecystectomies and PEH repairs between June 2018 and November 2020. Patients who had a concomitant procedure, a revisional surgery, or bilateral inguinal hernia repair were excluded from the study. Cost analysis was performed using a micro-costing approach. Statistical significance was denoted by p < 0.05. There were no differences among the different groups in relation to age, gender, ethnicity, and BMI. The overall cost of the robotic (R-) approach compared to a laparoscopic (L-) approach was significantly lower for cholecystectomy ($3,199.96 vs $4019.89, p < 0.05). For inguinal hernia repairs and PEH repairs without mesh, we found no significant difference in overall costs between the R- and L- approach (R- $3835.06 vs L- $3783.50, p = 0.69) and (R- $6852.41 vs L- $6819.69, p = 0.97), respectively. However, the overall cost of PEH with mesh was significantly higher for the R- group compared to the L- group (R- $7,511.09 vs L- $6,443.32, p < 0.05). Based on our institutional cost data, use of a robotic approach when performing certain general surgery cases does not seem to be cost prohibitive.

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Authors and Affiliations

  1. Temple/St. Luke’s School of Medicine, Bethlehem, PA, USA

    Eva Munshower & Emily Ren

  2. Department of Research and Innovation, St. Luke’s University Health Network, Bethlehem, PA, USA

    Wayne B. Bauerle & Jill Stoltzfus

  3. Cost Accounting Department, St. Luke’s University Health Network, Bethlehem, PA, USA

    Janice Ruland

  4. Department of Surgery, Division of Minimally Invasive Surgery, St. Luke’s University Hospital and Health Network, Allentown, PA, USA

    Marian McDonald & Daniel R. Baillie

  5. Department of Surgery, Division of Bariatric Surgery, St. Luke’s University Hospital and Health Network, Allentown, PA, USA

    Maher El Chaar

Authors
  1. Eva Munshower
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  2. Emily Ren
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  3. Wayne B. Bauerle
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  4. Janice Ruland
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  5. Jill Stoltzfus
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  8. Maher El Chaar
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Correspondence to Maher El Chaar.

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The senior author (MEC) is a paid consultant for Intuitive Surgical. All other authors declare they have no financial conflicts of interest to disclose.

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Munshower, E., Ren, E., Bauerle, W.B. et al. Cost analysis of robotic assisted general surgery cases in a single academic institution. J Robotic Surg 17, 557–564 (2023). https://doi.org/10.1007/s11701-022-01434-5

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  • DOI: https://doi.org/10.1007/s11701-022-01434-5

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