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Surgical Endoscopy

, Volume 31, Issue 3, pp 1436–1441 | Cite as

A retrospective comparison of robotic cholecystectomy versus laparoscopic cholecystectomy: operative outcomes and cost analysis

  • David S. Strosberg
  • Michelle C. Nguyen
  • Peter MuscarellaII
  • Vimal K. Narula
Article

Abstract

Introduction

Robotic-assisted surgery is gaining popularity in general surgery. Our objective was to evaluate and compare operative outcomes and total costs for robotic cholecystectomy (RC) and laparoscopic cholecystectomy (LC).

Methods and Procedures

A retrospective review was performed for all patients who underwent single-procedure RC and LC from January 2011 to July 2015 by a single surgeon at a large academic medical center. Demographics, diagnosis, perioperative variables, postoperative complications, 30-day readmissions, and operative and hospital costs were collected and analyzed between those patient groups.

Results

A total of 237 patients underwent RC or LC, and comprised the study population. Ninety-seven patients (40.9 %) underwent LC, and 140 patients (50.1 %) underwent RC. Patients who underwent RC had a higher body mass index (p = 0.03), lower rates of coronary artery disease (p < 0.01), and higher rates of chronic cholecystitis (p < 0.01). There were lower rates of intraoperative cholangiography (p < 0.01) and conversion to an open procedure (p < 0.01), however longer operative times (p < 0.01) for patients in the RC group. There were no bile duct injuries in either group, no difference in bile leak rates (p = 0.65), or need for reoperation (p = 1.000). Cost analysis of outpatient-only procedures, excluding cases with conversion to open or use of intraoperative cholangiography, demonstrated higher total charges (p < 0.01) and cost (p < 0.01) and lower revenue (p < 0.01) for RC compared to LC, with no difference in total payments (p = 0.34).

Conclusions

Robotic cholecystectomy appears to be safe although costlier in comparison with laparoscopic cholecystectomy. Further studies are needed to understand the long-term implications of robotic technology, the cost to the health care system, and its role in minimally invasive surgery.

Keywords

Robotic surgery Laparoscopic surgery Cholecystectomy Cost analysis 

Notes

Acknowledgements

The authors would like to thank Rebecca Dettorre, MA, CCRC, senior research coordinator, for her work in the facilitation of this study.

Compliance with ethical standards

Disclosure

David S. Strosberg, Michelle C. Nguyen, Peter Muscarella II, and Vimal K. Narula have no conflict of interest in writing this manuscript.

References

  1. 1.
    Cullen KA, Hall MJ, Golosinskiy A (2009) Ambulatory surgery in the United States, 2006. Natl Health Stat Rep 11:1–25Google Scholar
  2. 2.
    Harrell AG, Heniford BT (2005) Minimally invasive abdominal surgery: lux et veritas past, present, and future. Am J Surg 190(2):239–243CrossRefPubMedGoogle Scholar
  3. 3.
    Rodriguez-Sanjuan JC, Gomez-Ruiz M, Trugeda-Carrera S, Manuel-Palazuelos C, Lopez-Useros A, Gomez-Fleitas M (2016) Laparoscopic and robot-assisted laparoscopic digestive surgery: present and future directions. World J Gastroenterol 22(6):1975–2004CrossRefPubMedPubMedCentralGoogle Scholar
  4. 4.
    Lanfranco AR, Castellanos AE, Desai JP, Meyers WC (2004) Robotic surgery: a current perspective. Ann Surg 239(1):14–21CrossRefPubMedPubMedCentralGoogle Scholar
  5. 5.
    Kang J, Yoon KJ, Min BS, Hur H, Baik SH, Kim NK, Lee KY (2013) The impact of robotic surgery for mid and low rectal cancer: a case-matched analysis of a 3-arm comparison–open, laparoscopic, and robotic surgery. Ann Surg 257(1):95–101CrossRefPubMedGoogle Scholar
  6. 6.
    Baek NH, Li G, Kim JH, Hwang JC, Kim JH, Yoo BM, Kim WH (2015) Short-term surgical outcomes and experience with 925 patients undergoing robotic cholecystectomy during A 4-year period at a single institution. Hepatogastroenterology 62(139):573–576PubMedGoogle Scholar
  7. 7.
    Newman RM, Umer A, Bozzuto BJ, Dilungo JL, Ellner S (2016) Surgical value of elective minimally invasive gallbladder removal: a cost analysis of traditional 4-port vs single-incision and robotically assisted cholecystectomy. J Am Coll Surg 222(3):303–308CrossRefPubMedGoogle Scholar
  8. 8.
    Uhrich ML, Underwood RA, Standeven JW, Soper NJ, Engsberg JR (2002) Assessment of fatigue, monitor placement, and surgical experience during simulated laparoscopic surgery. Surg Endosc 16(4):635–639CrossRefPubMedGoogle Scholar
  9. 9.
    SAGES-MIRA Robotic Surgery Consensus Group. A consensus document on robotic surgery. Society of American Gastrointestinal and Endoscopic Surgeons. http://www.sages.org/publications/guidelines/consensus-documentrobotic-surgery/
  10. 10.
    Casillas MA Jr, Leichtle SW, Wahl WL, Lampman RM, Welch KB, Wellock T, Madden EB, Cleary RK (2014) Improved perioperative and short-term outcomes of robotic versus conventional laparoscopic colorectal operations. Am J Surg 208(1):33–40CrossRefPubMedGoogle Scholar
  11. 11.
    Lin S, Jiang HG, Chen ZH, Zhou SY, Liu XS, Yu JR (2011) Meta-analysis of robotic and laparoscopic surgery for treatment of rectal cancer. World J Gastroenterol 17(47):5214–5220CrossRefPubMedPubMedCentralGoogle Scholar
  12. 12.
    Liao GX, Xie GZ, Li R, Zhao ZH, Sun QQ, Du SS, Ren C, Li GX, Deng HJ, Yuan YW (2013) Meta-analysis of outcomes compared between robotic and laparoscopic gastrectomy for gastric cancer. Asian Pac J Cancer Prev 14(8):4871–4875CrossRefPubMedGoogle Scholar
  13. 13.
    Snyder BE, Wilson T, Leong BY, Klein C, Wilson EB (2010) Robotic-assisted Roux-en-Y Gastric bypass: minimizing morbidity and mortality. Obes Surg 20(3):265–270CrossRefPubMedGoogle Scholar
  14. 14.
    Tsung A, Geller DA, Sukato DC, Sabbaghian S, Tohme S, Steel J, Marsh W, Reddy SK, Bartlett DL (2014) Robotic versus laparoscopic hepatectomy: a matched comparison. Ann Surg 259(3):549–555CrossRefPubMedGoogle Scholar
  15. 15.
    Gonzalez A, Murcia CH, Romero R, Escobar E, Garcia P, Walker G, Gallas M, Dickens E, McIntosh B, Norwood W, Kim K, Rabaza J, Parris D (2016) A multicenter study of initial experience with single-incision robotic cholecystectomies (SIRC) demonstrating a high success rate in 465 cases. Surg Endosc 30(7):2951–2960CrossRefPubMedGoogle Scholar
  16. 16.
    Gustafson M, Lescouflair T, Kimball R, Daoud I (2016) A comparison of robotic single-incision and traditional single-incision laparoscopic cholecystectomy. Surg Endosc 30(6):2276–2280CrossRefPubMedGoogle Scholar
  17. 17.
    Pietrabissa A, Pugliese L, Vinci A, Peri A, Tinozzi FP, Cavazzi E, Pellegrino E, Klersy C (2016) Short-term outcomes of single-site robotic cholecystectomy versus four-port laparoscopic cholecystectomy: a prospective, randomized, double-blind trial. Surg Endosc 30(7):3089–3097CrossRefPubMedGoogle Scholar
  18. 18.
    Salman M, Bell T, Martin J, Bhuva K, Grim R, Ahuja V (2013) Use, cost, complications, and mortality of robotic versus nonrobotic general surgery procedures based on a nationwide database. Am Surg 79(6):553–560PubMedGoogle Scholar
  19. 19.
    Brauer DG, Hawkins WG, Strasberg SM, Brunt LM, Jaques DP, Mercurio NR, Hall BL, Fields RC (2015) Cost variation in a laparoscopic cholecystectomy and the association with outcomes across a single health system: implications for standardization and improved resource utilization. HPB (Oxford). 17(12):1113–1118CrossRefPubMedPubMedCentralGoogle Scholar

Copyright information

© Springer Science+Business Media New York 2016

Authors and Affiliations

  • David S. Strosberg
    • 1
  • Michelle C. Nguyen
    • 1
  • Peter MuscarellaII
    • 2
  • Vimal K. Narula
    • 1
  1. 1.Division of General and Gastrointestinal Surgery, Center for Minimally Invasive SurgeryThe Ohio State University Wexner Medical CenterColumbusUSA
  2. 2.Montefiore M-E Center for Cancer CareBronxUSA

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