European Archives of Oto-Rhino-Laryngology

, Volume 271, Issue 10, pp 2825–2834 | Cite as

Cost comparison of open approach, transoral laser microsurgery and transoral robotic surgery for partial and total laryngectomies

  • Manon Dombrée
  • Ralph Crott
  • Georges Lawson
  • Pascal Janne
  • Annick Castiaux
  • Bruno KrugEmail author


Activity-based costing is used to give a better insight into the actual cost structure of open, transoral laser microsurgery (TLM) and transoral robotic surgery (TORS) supraglottic and total laryngectomies. Cost data were obtained from hospital administration, personnel and vendor structured interviews. A process map identified 17 activities, to which the detailed cost data are related. One-way sensitivity analyses on the patient throughput, the cost of the equipment or operative times were performed. The total cost for supraglottic open (135–203 min), TLM (110–210 min) and TORS (35–130 min) approaches were 3,349 € (3,193–3,499 €), 3,461 € (3,207–3,664 €) and 5,650 € (4,297–5,974 €), respectively. For total laryngectomy, the overall cost were 3,581 € (3,215–3,846 €) for open and 6,767 € (6,418–7,389 €) for TORS. TORS cost is mostly influenced by equipment (54 %) where the other procedures are predominantly determined by personnel cost (about 45 %). Even when we doubled the yearly case-load, used the shortest operative times or a calculation without robot equipment costs we did not reach cost equivalence. TORS is more expensive than standard approaches and mainly influenced by purchase and maintenance costs and the use of proprietary instruments. Further trials on long-term outcomes and costs following TORS are needed to evaluate its cost-effectiveness.


Cost analysis Activity-based costing Laryngeal cancer Laryngectomy Robotic surgery 


Conflict of interest

Hereby, all authors declare that we do not have any conflicts of interest in the manuscript, including financial, consultant, institutional and other relationships that might lead to bias or a conflict of interest.


  1. 1.
    Ferlay J, Shin HR, Bray F, Forman D, Mathers C, Parkin DM (2010) Estimates of worldwide burden of cancer in 2008: globocan 2008. Int J Cancer 127:2893–2917PubMedCrossRefGoogle Scholar
  2. 2.
    Lawson G, Mendelsohn AH, Van Der Vorst S, Bachy V, Remacle M (2013) Transoral robotic surgery total laryngectomy. Laryngoscope 123:193–196PubMedCrossRefGoogle Scholar
  3. 3.
    Weinstein GS, O’Malley BW Jr, Magnuson JS, Carroll WR, Olsen KD, Daio L, Moore EJ, Holsinger FC (2012) Transoral robotic surgery: a multicenter study to assess feasibility, safety, and surgical margins. Laryngoscope 122:1701–1707PubMedCrossRefGoogle Scholar
  4. 4.
    Vergez S, Lallemant B, Ceruse P, Moriniere S, Aubry K, De Mones E, Benlyazid A, Mallet Y (2012) Initial multi-institutional experience with transoral robotic surgery. Otolaryngol Head Neck Surg 147:475–481PubMedCrossRefGoogle Scholar
  5. 5.
    Ozer E, Alvarez B, Kakarala K, Durmus K, Teknos TN, Carrau RL (2013) Clinical outcomes of transoral robotic supraglottic laryngectomy. Head Neck 35(8):1158–1161PubMedCrossRefGoogle Scholar
  6. 6.
    Oliveira CM, Nguyen HT, Ferraz AR, Watters K, Rosman B, Rahbar R (2012) Robotic surgery in otolaryngology and head and neck surgery: a review. Minim Invasive Surg 2012:286563PubMedCentralPubMedGoogle Scholar
  7. 7.
    Maan ZN, Gibbins N, Al-Jabri T, D’Souza AR (2012) The use of robotics in otolaryngology-head and neck surgery: a systematic review. Am J Otolaryngol 33:137–146PubMedCrossRefGoogle Scholar
  8. 8.
    Lotan Y (2010) Economics of robotics in urology. Curr Opin Urol 20:92–97PubMedCrossRefGoogle Scholar
  9. 9.
    Turchetti G, Palla I, Pierotti F, Cuschieri A (2012) Economic evaluation of da Vinci-assisted robotic surgery: a systematic review. Surg Endosc 26:598–606PubMedCrossRefGoogle Scholar
  10. 10.
    Monge P (2006) The importance of activity-based methods in radiology and the technology that now makes this possible. Radiol Manage 28:52–55PubMedGoogle Scholar
  11. 11.
    Player S (1998) Activity-based analyses lead to better decision making. Healthc Financ Manage 52:66–70PubMedGoogle Scholar
  12. 12.
    Nisenbaum HL, Birnbaum BA, Myers MM, Grossman RI, Gefter WB, Langlotz CP (2000) The costs of CT procedures in an academic radiology department determined by an activity-based costing (ABC) method. J Comput Assist Tomogr 24:813–823PubMedCrossRefGoogle Scholar
  13. 13.
    Canby JBt (1995) Applying activity-based costing to healthcare settings. Healthc Financ Manage 49(50–52):4–6Google Scholar
  14. 14.
    Gabram SG, Mendola RA, Rozenfeld J, Gamelli RL (1997) Why activity-based costing works. Physician Exec 23:31–37PubMedGoogle Scholar
  15. 15.
    Ross TK (2004) Analyzing health care operations using ABC. J Health Care Finance 30:1–20PubMedGoogle Scholar
  16. 16.
    Baker J (1998) Activity-based costing and activity-based management for health careGoogle Scholar
  17. 17.
    Baker JJ, Boyd GF (1997) Activity-based costing in the operating room at Valley View Hospital. J Health Care Finance 24:1–9PubMedGoogle Scholar
  18. 18.
    Cinquini L, Miolo Vitali P, Pitzalis A, CC (2007) Cost measurement in laparoscopic surgery: results from an activity-based costing application. Annual HCTM conference. PisaGoogle Scholar
  19. 19.
    Swartenbroekx N, Obyn C, Guillaume P, Lona M, Cleemput I (2012) Manual for cost-based pricing of hospital interventions. In: health technology assessment (HTA). Belgian Health Care Knowledge Centre (KCE), Brussels. KCE Report 178C. D/2012/10.273/31Google Scholar
  20. 20.
    Cleemput I, Neyt M, Van de Sande S, Thiry N (2012) Belgian guidelines for economic evaluations and budget impact analyses: second edition. In : Health technology assessment (HTA). Belgian Health Care Knowledge Centre (KCE), BrusselsGoogle Scholar
  21. 21.
    Broome JT, Pomeroy S, Solorzano CC (2012) Expense of robotic thyroidectomy: a cost analysis at a single institution. Arch Surg 147:1102–1106PubMedCrossRefGoogle Scholar
  22. 22.
    Cabot JC, Lee CR, Brunaud L, Kleiman DA, Chung WY, Fahey TJ 3rd, Zarnegar R (2012) Robotic and endoscopic transaxillary thyroidectomies may be cost prohibitive when compared to standard cervical thyroidectomy: a cost analysis. Surgery 152:1016–1024PubMedCrossRefGoogle Scholar
  23. 23.
    Arora A, Cunningham A, Chawdhary G, Vicini C, Weinstein GS, Darzi A, Tolley N (2011) Clinical applications of telerobotic ENT-head and neck surgery. Int J Surg 9:277–284PubMedCrossRefGoogle Scholar
  24. 24.
    Hans S, Badoual C, Gorphe P, Brasnu D (2012) Transoral robotic surgery for head and neck carcinomas. Eur Arch Otorhinolaryngol 269:1979–1984PubMedCrossRefGoogle Scholar
  25. 25.
    Luthringer T, Aleksic I, Caire A, Albala DM (2012) Developing a successful robotics program. Curr Opin Urol 22:40–46PubMedCrossRefGoogle Scholar
  26. 26.
    Schreuder HW, Wolswijk R, Zweemer RP, Schijven MP, Verheijen RH (2012) Training and learning robotic surgery, time for a more structured approach: a systematic review. BJOG 119:137–149PubMedCrossRefGoogle Scholar
  27. 27.
    Smith RV, Schiff BA, Sarta C, Hans S, Brasnu D (2013) Transoral robotic total laryngectomy. Laryngoscope 123:678–682PubMedCrossRefGoogle Scholar
  28. 28.
    Dowthwaite S, Nichols AC, Yoo J, Smith RV, Dhaliwal S, Basmaji J, Franklin JH, Fung K (2013) Transoral robotic total laryngectomy: report of 3 cases. Head Neck 35(11):E338–E342PubMedCrossRefGoogle Scholar
  29. 29.
    Delaney CP, Senagore AJ, Ponsky L (2010) Robot-assisted surgery and health care costs. N Engl J Med 363:2175; author reply 6Google Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 2014

Authors and Affiliations

  • Manon Dombrée
    • 1
  • Ralph Crott
    • 6
  • Georges Lawson
    • 2
    • 3
  • Pascal Janne
    • 2
    • 4
  • Annick Castiaux
    • 1
    • 2
  • Bruno Krug
    • 2
    • 4
    • 5
    • 6
    Email author
  1. 1.Business Administration DepartmentUniversity of NamurNamurBelgium
  2. 2.Namur Research Institute for Life SciencesUniversity of NamurNamurBelgium
  3. 3.Department of Head and Neck SurgeryCHU UCL Mont-Godinne–DinantYvoirBelgium
  4. 4.AdministrationCHU UCL Mont-Godinne–DinantYvoirBelgium
  5. 5.Nuclear Medicine DivisionCHU UCL Mont-Godinne–Dinant, Université Catholique de LouvainYvoirBelgium
  6. 6.Institute of Health and SocietyUniversité Catholique de LouvainYvoirBelgium

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