Surgical Endoscopy

, Volume 26, Issue 3, pp 598–606 | Cite as

Economic evaluation of da Vinci-assisted robotic surgery: a systematic review

  • Giuseppe Turchetti
  • Ilaria Palla
  • Francesca Pierotti
  • Alfred Cuschieri



Health technology assessment (HTA) is frequently used when a new and expensive technology is being introduced into clinical practice. This certainly is the case with the da Vinci surgical robot, with costs ranging from $1 to $2.5 million for each unit. This systematic review documents major variability in the reported cost evaluation studies of da Vinci robot-assisted operations compared with those performed by the direct manual laparoscopic approach.


Published studies in the English language related to the period 2000–2010 were searched using economic and clinical electronic databases.


All 11 reports included some form of cost analysis, which made it possible for the authors to extract information on certain specific economic outcomes: operating room time, hospital stay, and total costs. With the exception of two studies, the reported operating room time was higher with the robotic approach than with manual laparoscopic surgery, and the hospital stay was the same for the two techniques. Robotic surgery is significantly more expensive if the purchase and maintenance costs of the robot system are included in the total costs. Only 3 of the 11 publications included these costs.


The disadvantage of robotic surgery is its higher costs related to purchase and maintenance of technology and its longer operating room time. However, emerging evidence shows that operating room time decreases with experience using the robot. From the HTA viewpoint, the result of this review is that the jury still is out on the HTA of da Vinci-assisted robotic surgery.


da Vinci Direct manual laparoscopic surgery Health economic evaluation 



The authors thank the clinical units involved in the project. They also thank Professors Mario Morino and Fabrizio Rebecchi from Le Molinette University Hospital of Turin, Professor Lorenzo Spaggiari and Dr Domenico Galetta from European Oncology Institute of Milan, and Professor Alfredo Mussi, Dr Franca Melfi, Dr Federico Davini, Dr Vito Cela, and Dr Nicola Pluchino from the University Hospital of Pisa. The study was funded by a MIUR grant in the 2008 PRIN program: Health Technology Assessment of the da Vinci Master Slave Manipulator in Italy (CUP code J51J10000000001).


Giuseppe Turchetti, Ilaria Palla, Francesca Pierotti, and Alfred Cuschieri have no conflicts of interests or financial ties to disclose.


  1. 1.
    Institute of Medicine (1985) Assessing medical technologies. National Academy Press, WashingtonGoogle Scholar
  2. 2.
    Banta HD, Luce BR (1993) Health care technology and its assessment: an international perspective. Oxford University Press, New YorkGoogle Scholar
  3. 3.
    Goodman CS (2004) Introduction to health technology assessment. The Lewin Group, Falls ChurchGoogle Scholar
  4. 4.
    Turchetti G, Spadoni E, Geisler E (2010) Health technology assessment: evaluation of biomedical innovative technologies. IEEE Eng Med Biol Mag 29:70–76PubMedCrossRefGoogle Scholar
  5. 5.
    Drummond MF, O’Brien BJ, Stoddart GL, Torrance GW (1998) Methods for the economic evaluation of health care programmes. Oxford University Press, OxfordGoogle Scholar
  6. 6.
    Barbash GI, Glied SA (2010) New technology and health care costs: the case of robot-assisted surgery. New Engl J Med 363:701–704PubMedCrossRefGoogle Scholar
  7. 7.
    Centre For Reviews Dissemination (2008) CRD’s guidance for undertaking reviews in health care. University of York, YorkGoogle Scholar
  8. 8.
    Higgins JPT, Green S (eds) (2008) Cochrane handbook for systematic reviews of interventions. Wiley-Blackwell, ChichesterGoogle Scholar
  9. 9.
    Evers S, Goossens M, De Vet H, Van Tulder M, Ament A (2005) Criteria list for assessment of methodological quality of economic evaluations: consensus on health economic criteria. Int J Tech Assess Health Care 21:240–245Google Scholar
  10. 10.
    Lotan Y, Cadeddu JA, Gettman MT (2004) The new economics of radical prostatectomy: cost comparison of open, laparoscopic, and robot-assisted techniques. J Urol 172:1431–1435PubMedCrossRefGoogle Scholar
  11. 11.
    Morino M, Beninca G, Giraudo G, Del Genio GM, Rebecchi F, Garrone C (2004) Robotic-assisted versus laparoscopic adrenalectomy. Surg Endosc 18:1742–1746PubMedCrossRefGoogle Scholar
  12. 12.
    Heemskerk J, van Dam R, van Gemert WG, Beets GL, Greve JWM, Jacobs MJHM, Bouvy ND (2006) First results after introduction of the four-armed da Vinci surgical system in fully robotic laparoscopic cholecystectomy. Dig Surg 22:426–431CrossRefGoogle Scholar
  13. 13.
    Morino M, Pellegrino L, Giaccone C, Garrone C, Rebecchi F (2006) Randomized clinical trial of robot-assisted versus laparoscopic Nissen fundoplication. Br J Surg 93:553–558PubMedCrossRefGoogle Scholar
  14. 14.
    El Nakadi I, Mélot C, Closset J, De Moor V, Bétroune K, Feron P, Lingier P, Gelin M (2006) Evaluation of da Vinci Nissen fundoplication: clinical results and cost minimization. World J Surg 30:1050–1054CrossRefGoogle Scholar
  15. 15.
    Rawlings AL, Woodland JH, Vegunta RK, Crawford DL (2007) Robotic versus laparoscopic colectomy. Surg Endosc 21:1701–1708PubMedCrossRefGoogle Scholar
  16. 16.
    Heemskerk J, de Hoog DENM, van Gemert WG, Baeten CGMI, Greve JWM, Bouvy ND (2007) Robot-assisted vs conventional laparoscopic rectopexy for rectal prolapse: a comparative study on costs and time. Dis Colon Rectum 50:1825–1830PubMedCrossRefGoogle Scholar
  17. 17.
    Breitenstein S, Nocito A, Puhan M, Held U, Weber M, Clavien PA (2008) Robotic-assisted versus laparoscopic cholecystectomy: outcome and cost analyses of a case-matched control study. Ann Surg 247:987–993PubMedCrossRefGoogle Scholar
  18. 18.
    Park BJ, Flores RM (2008) Cost comparison of robotic, video-assisted thoracic surgery and thoracotomy approaches to pulmonary lobectomy. Thorac Surg Clin 18:297–300PubMedCrossRefGoogle Scholar
  19. 19.
    Sarlos D, Kots L, Stevanovic N, Schaer G (2010) Robotic hysterectomy versus conventional laparoscopic hysterectomy: outcome and cost analyses of a matched case-control study. Eur J Obstet Gynecol Reprod Biol 150:92–96PubMedCrossRefGoogle Scholar
  20. 20.
    Bolenz C, Gupta A, Hotze T, Ho R, Cadeddu JA, Roehrborn CG, Lotan Y (2010) Cost comparison of robotic, laparoscopic, and open radical prostatectomy for prostate cancer. Eur Eurol 57:453–458Google Scholar
  21. 21.
    de Souza AL, Prasad LM, Marecik SJ, Blumetti J, Park JJ, Zimmern A, Abcarian H (2010) Total mesorectal excision for rectal cancer: the potential advantage of robotic assistance. Dis Colon Rectum 53:1611–1617CrossRefGoogle Scholar
  22. 22.
    Zhou NX, Chen JZ, Liu Q, Zhang X, Wang Z, Ren S, Chen XF (2011) Outcomes of pancreatoduodenectomy with robotic surgery versus open surgery. Int J Med Robot. doi:  10.1002/rcs.380. Epub ahead of print PubMed PMID: 21412963
  23. 23.
    D’Annibale A, Pende V, Pernazza G, Monsellato I, Mazzocchi P, Lucandri G, Morpurgo E, Contardo T, Sovernigo G (2011) Full robotic gastrectomy with extended (D2) lymphadenectomy for gastric cancer: surgical technique and preliminary results. J Surg Res 166:e113–e120. Epub 13 Dec 2010. PubMed PMID: 21227455Google Scholar
  24. 24.
    Horiguchi A, Uyama I, Miyakawa S (2011) Robot-assisted laparoscopic pancreaticoduodenectomy. J Hepatobiliary Pancreat Sci 18:287–291PubMedCrossRefGoogle Scholar
  25. 25.
    Hur H, Kim JY, Cho YK, Han SU (2010) Technical feasibility of robot-sewn anastomosis in robotic surgery for gastric cancer. J Laparoendosc Adv Surg Tech A 20:693–697PubMedCrossRefGoogle Scholar
  26. 26.
    Erdeljan P, Caumartin Y, Warren J, Nguan C, Nott L, Luke PP, Pautler SE (2010) Robot-assisted pyeloplasty: follow-up of first Canadian experience with comparison of outcomes between experienced and trainee surgeons. J Endourol 24:1447–1450PubMedCrossRefGoogle Scholar
  27. 27.
    Stádler P, Dvoracek L, Vitasek P, Matous P (2010) Robotic vascular surgery: 150 cases. Int J Med Robot 6:394–398PubMedCrossRefGoogle Scholar
  28. 28.
    Stádler P (2009) Role of the robot in totally laparoscopic aortic repair for occlusive and aneurysmal disease. Acta Chir Belg 109:300–305PubMedGoogle Scholar
  29. 29.
    Huettner F, Dynda D, Ryan M, Doubet J, Crawford DL (2010) Robotic-assisted minimally invasive surgery: a useful tool in resident training: the Peoria experience, 2002–2009. Int J Med Robot 6:386–393PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2011

Authors and Affiliations

  • Giuseppe Turchetti
    • 1
  • Ilaria Palla
    • 1
  • Francesca Pierotti
    • 1
  • Alfred Cuschieri
    • 1
  1. 1.Scuola Superiore Sant’AnnaPisaItaly

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