Skip to main content

Advertisement

SpringerLink
Log in

Cost-effectiveness analysis of robot-assisted laparoscopic surgery for complex pediatric surgical conditions

  • Published:
Surgical Endoscopy Aims and scope Submit manuscript

Abstract

Background

Robotics has been used safely and successfully in a variety of adult surgeries and is gradually gaining ground in pediatrics. While the benefits of robotic-assisted surgery in disease treatment are well recognized, its high cost has led to questions. To investigate whether robotic-assisted laparoscopic surgery (RALS) is cost-effective compared to conventional laparoscopic surgery (LS) in pediatric surgery, we attempted to construct a model to perform an analysis of these two surgical approaches using Python statistical analysis software.

Methods

We selected four common complex pediatric surgical conditions (choledochal cyst, Hirschsprung's disease, vesicoureteral reflux, and congenital hydronephrosis) from three systems (pediatric hepatobiliary, gastroenterology, and urology). Models were constructed using Python statistical software to compare hospital costs and surgical outcomes for RALS and LS. In addition, we performed a preferred strategy analysis for both surgical modalities while assessing model uncertainty using one-way sensitivity analysis.

Results

For the four diseases, the operative time decreased sequentially. The total inpatient costs of RALS were 10,816.72, 9145.44, 8414.29, 7973.58 dollars, respectively, yielding 1.789, 1.712, 1.749, 1.792 quality adjustment life years (QALYs) over two years post-operatively. The incremental cost of RALS relative to LS for each disease was 3523.44, 3200.20, 3049.79, 3043.66 dollars, respectively, with an incremental utility of 0.060, 0.054, 0.051, 0.050 QALYs. The incremental cost-effectiveness ratios (ICERs) for RALS for each of the four diseases were 58,724.01, 59,262.95, 59,799.79, 60,873.20 dollars/QALY, all less than 100,000 dollars/QALY. The cost of robot consumables was the main incremental cost of RALS and had the most significant impact on the model.

Conclusion

For the four pediatric surgical conditions described above, RALS has higher inpatient costs than LS, but it has better postoperative outcomes, and all four RALS treatments are cost-effective. Children with complex diseases and long operative times appear to benefit more from RALS.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4

Similar content being viewed by others

References

  1. Lane T (2018) A short history of robotic surgery. Ann R Coll Surg Engl 100:5–7

    Article  PubMed  PubMed Central  Google Scholar 

  2. Leal Ghezzi T, Campos Corleta O (2016) 30 years of robotic surgery. World J Surg 40(10):2550–2557

    Article  PubMed  Google Scholar 

  3. Mikhail D, Sarcona J, Mekhail M, Richstone L (2020) Urologic Robotic Surgery. Surg Clin 100(2):361–378

    Google Scholar 

  4. Woo YJ (2006) Robotic cardiac surgery. Int J Med Robot Comput Assist Surg. 2(3):225–232

    Article  Google Scholar 

  5. Chen S, Geraci TC, Cerfolio RJ (2018) Techniques for lung surgery: a review of robotic lobectomy. Expert Rev Respir Med 12(4):315–322

    Article  CAS  PubMed  Google Scholar 

  6. Rivas-López R, Sandoval-García-Travesí FA (2020) Robotic surgery in gynecology: review of literature. Cir Cir 88(1):107–116

    Google Scholar 

  7. Denning NL, Kallis MP, Prince JM (2020) Pediatric robotic surgery. Surg Clin 100(2):431–443

    Google Scholar 

  8. Chaussy Y, Becmeur F, Lardy H, Aubert D (2013) Robot-assisted surgery: current status evaluation in abdominal and urological pediatric surgery. J Laparoendosc Adv Surg Tech 23(6):530–538

    Article  Google Scholar 

  9. Fernandez N, Barco-Castillo C, ElGhazzaoui A, Farhat W (2021) Effective intracorporeal space in robot-assisted multiquadrant surgery in a pediatric inanimate model. J Robot Surg 15(1):25–30

    Article  Google Scholar 

  10. Binet A, Ballouhey Q, Chaussy Y, de Lambert G, Braïk K, Villemagne T, Becmeur F, Fourcade L, Lardy H (2018) Current perspectives in robot-assisted surgery. Minerva Pediatr 70(3):308–314

    Article  PubMed  Google Scholar 

  11. Leijte E, de Blaauw I, Van Workum F, Rosman C, Botden S (2020) Robot assisted versus laparoscopic suturing learning curve in a simulated setting. Surg Endosc 34(8):3679–3689

    Article  PubMed  Google Scholar 

  12. O’Kelly F, Farhat WA, Koyle MA (2020) Cost, training and simulation models for robotic-assisted surgery in pediatric urology. World J Urol 38(8):1875–1882

    Article  CAS  PubMed  Google Scholar 

  13. Dalager T, Jensen PT, Eriksen JR, Jakobsen HL, Mogensen O, Søgaard K (2020) Surgeons’ posture and muscle strain during laparoscopic and robotic surgery. Br J Surg 107(6):756–766

    Article  CAS  PubMed  Google Scholar 

  14. Dalsgaard T, Jensen MD, Hartwell D, Mosgaard BJ, Jørgensen A, Jensen BR (2020) Robotic surgery is less physically demanding than laparoscopic surgery: paired cross sectional study. Ann Surg 271(1):106–113

    Article  PubMed  Google Scholar 

  15. Wang X, Cao G, Mao W, Lao W, He C (2020) Robot-assisted versus laparoscopic surgery for rectal cancer: a systematic review and meta-analysis. J Cancer Res Ther 16(5):979–989

    Article  PubMed  Google Scholar 

  16. Broholm M, Onsberg Hansen I, Rosenberg J (2016) Limited evidence for robot-assisted surgery: a systematic review and meta-analysis of randomized controlled trials. Surg Laparosc, Endosc Percutaneous Tech 26(2):117–123

    Article  Google Scholar 

  17. Crocerossa F, Carbonara U, Cantiello F, Marchioni M, Ditonno P, Mir MC, Porpiglia F, Derweesh I, Hampton LJ, Damiano R, Autorino R (2021) Robot-assisted radical nephrectomy: a systematic review and meta-analysis of comparative studies. Eur Urol 80(4):428–439

    Article  PubMed  Google Scholar 

  18. Chen SH, Li ZA, Du XP (2016) Robot-assisted versus conventional laparoscopic surgery in the treatment of advanced stage endometriosis: a meta-analysis. Clin Exp Obstet Gynecol 43(3):422–426

    Article  PubMed  Google Scholar 

  19. Du Y, Long Q, Guan B, Mu L, Tian J, Jiang Y, Bai X, Wu D (2018) Robot-assisted radical prostatectomy is more beneficial for prostate cancer patients: a system review and meta-analysis. Med Sci Monitor: Int Med J Exp Clin Res 24:272–287

    Article  Google Scholar 

  20. Henriksen NA, Jensen KK, Muysoms F (2019) Robot-assisted abdominal wall surgery: a systematic review of the literature and meta-analysis. Hernia 23(1):17–27

    Article  CAS  PubMed  Google Scholar 

  21. Guerrini GP, Esposito G, Magistri P, Serra V, Guidetti C, Olivieri T, Catellani B, Assirati G, Ballarin R, Di Sandro S, Di Benedetto F (2020) Robotic versus laparoscopic gastrectomy for gastric cancer: the largest meta-analysis. Int J Surg 82:210–228

    Article  PubMed  Google Scholar 

  22. O’Neill M, Moran PS, Teljeur C, O’Sullivan OE, O’Reilly BA, Hewitt M, Flattery M, Ryan M (2013) Robot-assisted hysterectomy compared to open and laparoscopic approaches: systematic review and meta-analysis. Arch Gynecol Obstet 287(5):907–918

    Article  PubMed  Google Scholar 

  23. Freilich DA, Penna FJ, Nelson CP, Retik AB, Nguyen HT (2010) Parental satisfaction after open versus robot assisted laparoscopic pyeloplasty: results from modified glasgow children’s benefit inventory survey. J Urol 183(2):704–708

    Article  PubMed  Google Scholar 

  24. Wijburg CJ (2016) Cost-effectiveness of robotic surgery; what do we know? BJU Int 117(6):852–853

    Article  PubMed  Google Scholar 

  25. Lotan Y (2012) Is robotic surgery cost-effective: no. Curr Opin Urol 22(1):66–69

    Article  PubMed  Google Scholar 

  26. Boia ES, David VL (2019) The financial burden of setting up a pediatric robotic surgery program. Medicina 55(11):739

    Article  PubMed  PubMed Central  Google Scholar 

  27. Hopkins MB, Hawkins AT, Tiwari V, Soda M, Martin BJ, Muldoon RL, Ford MM, Beck D, Geiger TM (2022) Is newer always better?: comparing cost and short-term outcomes between laparoscopic and robotic right hemicolectomy. Surg Endosc 36(5):2879–2885

    Article  PubMed  Google Scholar 

  28. (2021) Notice of the National Health and Wellness Commission on the Issuance of the Healthy Child Action Enhancement Plan (2021–2025). Bulletin of the National Health and Wellness Commission of the People’s Republic of China. 28–32

  29. Neumann PJ, Cohen JT, Weinstein MC (2014) Updating cost-effectiveness–the curious resilience of the $50,000-per-QALY threshold. N Engl J Med 371(9):796–797

    Article  CAS  PubMed  Google Scholar 

  30. Hamada Y, Ando H, Kamisawa T, Itoi T, Urushihara N, Koshinaga T, Saito T, Fujii H, Morotomi Y (2016) Diagnostic criteria for congenital biliary dilatation 2015. J Hepatobiliary Pancreat Sci 23(6):342–346

    Article  PubMed  Google Scholar 

  31. Friedmacher F, Puri P (2013) Classification and diagnostic criteria of variants of Hirschsprung’s disease. Pediatr Surg Int 29(9):855–872

    Article  PubMed  Google Scholar 

  32. Greenbaum LA, Mesrobian HG (2006) Vesicoureteral reflux. Pediatr Clin North Am 53(413–427):vi

    PubMed  Google Scholar 

  33. Oliveira EA, Oliveira MC, Mak RH (2016) Evaluation and management of hydronephrosis in the neonate. Curr Opin Pediatr 28(2):195–201

    Article  PubMed  Google Scholar 

  34. Quynh TA, Hien PD, Du LQ, Long LH, Tran NTN, Hung T (2022) The follow-up of the robotic-assisted Soave procedure for Hirschsprung’s disease in children. J Robot Surg 16(2):301–305

    Article  PubMed  Google Scholar 

  35. Delgado-Miguel C, Camps JI (2022) Robotic soave pull-through procedure for Hirschsprung’s disease in children under 12-months: long-term outcomes. Pediatr Surg Int 38(1):51–57

    Article  PubMed  Google Scholar 

  36. Mattioli G, Pio L, Leonelli L, Razore B, Disma N, Montobbio G, Jasonni V, Petralia P, Pini Prato A (2017) A provisional experience with robot-assisted soave procedure for older children with Hirschsprung disease: back to the future? J Laparoendosc Adv Surg Tech 27(5):546–549

    Article  Google Scholar 

  37. Chi SQ, Cao GQ, Li S, Guo JL, Zhang X, Zhou Y, Tang ST (2021) Outcomes in robotic versus laparoscopic-assisted choledochal cyst excision and hepaticojejunostomy in children. Surg Endosc 35(9):5009–5014

    Article  PubMed  Google Scholar 

  38. Xie X, Feng L, Li K, Wang C, Xiang B (2021) Learning curve of robot-assisted choledochal cyst excision in pediatrics: report of 60 cases. Surg Endosc 35(6):2690–2697

    Article  PubMed  Google Scholar 

  39. Lin S, Chen J, Tang K, He Y, Xu X, Xu D (2022) Trans-umbilical single-site plus one robotic assisted surgery for choledochal cyst in children, a comparing to laparoscope-assisted procedure. Front Pediatr 10:806919

    Article  PubMed  PubMed Central  Google Scholar 

  40. Drain A, Jun MS, Zhao LC (2021) Robotic ureteral reconstruction. Urol Clinics N Am 48(1):91–101

    Article  Google Scholar 

  41. Carbonara U, Branche B, Cisu T, Crocerossa F, Guruli G, Grob MB, Roseman JT, Hampton LJ, Autorino R (2021) Robot-assisted ureteral reimplantation: a single-center comparative study. J Endourol 35(10):1504–1511

    Article  PubMed  Google Scholar 

  42. Andolfi C, Rodríguez VM, Galansky L, Gundeti MS (2021) Infant robot-assisted laparoscopic pyeloplasty: outcomes at a single institution, and tips for safety and success. Eur Urol 80(5):621–631

    Article  PubMed  Google Scholar 

  43. Davis TD, Burns AS, Corbett ST, Peters CA (2016) Reoperative robotic pyeloplasty in children. J Pediatr Urol 12(6):394.e1-394.e7

    Article  CAS  PubMed  Google Scholar 

  44. Crehuet Gramatyka D, Gutiérrez San Román C, Fonseca Martín R, Barrios Fontoba J, Mínguez Gómez A, Ortolá Fortes P, Diéguez Hernández-Vaquero I, Vila Carbó JJ (2019) Long term evaluation of transanal surgery with automatic suture in Hirschsprung’s disease. Cirugia pediatrica : organo oficial de la Sociedad Espanola de Cirugia Pediatrica 32(4):195–200

    CAS  Google Scholar 

  45. Tang J, Liu X, Ma T, Lv X, Jiang W, Zhang J, Lu C, Chen H, Li W, Li H, Xie H, Du C, Geng Q, Feng J, Tang W (2020) Application of enhanced recovery after surgery during the perioperative period in infants with Hirschsprung’s disease—a multi-center randomized clinical trial. Clin Nutr 39(7):2062–2069

    Article  CAS  Google Scholar 

  46. Liem NT (2013) Laparoscopic surgery for choledochal cysts. J Hepatobiliary Pancreat Sci 20(5):487–491

    Article  PubMed  Google Scholar 

  47. Zheng J, Li Z, Ye Y, Wang B (2020) Short-term complications after laparoscopic choledochal cyst radical surgery: prevention and treatment. Front Surg 7:583210

    Article  PubMed Central  Google Scholar 

  48. Qu X, Cui L, Xu J (2019) Laparoscopic Surgery in the treatment of children with choledochal cyst. Pakistan J Med Sci 35(3):807–811

    Google Scholar 

  49. Castillo OA, Zubieta R, Yanez R (2013) Laparoscopic surgery of vesicoureteral reflux: an experience in 42 patients with the Lich-Gregoir extravesical technique. Actas Urol Esp 37(10):630–633

    Article  CAS  Google Scholar 

  50. Yağız B, Demirel BD (2021) Ureteral reimplantation aligned laparoscopically: pneumovesicoscopic politano-leadbetter reimplantation in children. J Pediatr Urol 17(3):413.e1-413.e8

    Article  PubMed  Google Scholar 

  51. Peycelon M, Rembeyo G, Tanase A, Muller CO, Blanc T, Alhazmi H, Paye-Jaouen A, El Ghoneimi A (2020) Laparoscopic retroperitoneal approach for retrocaval ureter in children. World J Urol 38(8):2055–2062

    Article  Google Scholar 

  52. Heiberger C, Liu RW, Huang J, Kutsenko O (2020) Medicare physician fee schedule 2020: IR practice economic health and strategies to mitigate the undervaluing of IR services. J Vasc Interv Radiol 31(10):1726–1727

    Article  PubMed  PubMed Central  Google Scholar 

  53. Elden OE, Uleberg O, Lysne M, Haugdahl HS (2020) Community paramedicine-cost-benefit analysis and safety with paramedical emergency services in rural areas: scoping review protocol. British Med J Open 10(9):e038651

    Google Scholar 

  54. Ronis SD, Grossberg R, Allen R, Hertz A, Kleinman LC (2019) Estimated nonreimbursed costs for care coordination for children with medical complexity. Pediatrics 143(1):e20173562

    Article  PubMed  Google Scholar 

  55. HCUP (2011) HCUP facts and figures: statistics on hospital-based care in the United States, 2009. Agency for Healthcare Research and Quality

  56. Desai AD, Zhou C, Stanford S, Haaland W, Varni JW, Mangione-Smith RM (2014) Validity and responsiveness of the pediatric quality of life inventory (PedsQL) 40 generic core scales in the pediatric inpatient setting. JAMA Pediatr 168(7):1114–1121

    Article  PubMed  Google Scholar 

  57. Khan KA, Petrou S, Rivero-Arias O, Walters SJ, Boyle SE (2014) Mapping EQ-5D utility scores from the PedsQL generic core scales. Pharmacoeconomics 32(12):693–706

    Article  PubMed  Google Scholar 

  58. Mougeot M, Naegelen F (2018) Medical service provider networks. Health Econ 27(8):1201–1217

    Article  PubMed  Google Scholar 

  59. Meadows T, Valleley R, Haack MK, Thorson R, Evans J (2011) Physician “costs” in providing behavioral health in primary care. Clin Pediatr 50(5):447–455

    Article  Google Scholar 

  60. Lauren BN, Lim F, Krikhely A, Taveras EM, Woo Baidal JA, Bellows BK, Hur C (2022) Estimated cost-effectiveness of medical therapy, sleeve gastrectomy, and gastric bypass in patients with severe obesity and type 2 diabetes. JAMA Netw Open 5(2):e2148317

    Article  PubMed  PubMed Central  Google Scholar 

  61. Morrell ALG, Morrell-Junior AC, Morrell AG, Mendes JMF, Tustumi F, De Oliveira-E-Silva LG, Morrell A (2021) The history of robotic surgery and its evolution: when illusion becomes reality. Revista do Colegio Brasileiro de Cirurgioes 48:e20202798

    Article  PubMed  PubMed Central  Google Scholar 

  62. Xiao X, Xue L, Ye L, Li H, He Y (2021) Health care cost and benefits of artificial intelligence-assisted population-based glaucoma screening for the elderly in remote areas of China: a cost-offset analysis. BMC Public Health 21(1):1065

    Article  PubMed  PubMed Central  Google Scholar 

  63. Si Y, Zhou Z, Su M, Hu H, Yang Z, Chen X (2020) Comparison of health care utilization among patients affiliated and not affiliated with healthcare professionals in China. BMC Health Services Res 20(1):1118

    Article  Google Scholar 

  64. Wu Q, Pei H, Ran X, Chen X, Jiang L, Wei A, Xiang X, Wang Y, Gan X (2022) Qualitative study on the information needs of patients undergoing da vinci robotic surgery. Clin Nurs Res 14:10547738221103336

    Google Scholar 

Download references

Funding

Funding was provided by the National Natural Science Foundation of China with Grant Nos. 81873848, 82071689.

Author information

Authors and Affiliations

  1. Department of Pediatric Surgery, Tongji Medical College, Union Hospital, Huazhong University of Science and Technology, Wuhan, China

    Jiangrui Huang, Hong Mei, Liying Rong, Yun Zhou, Jialing Guo, Li Wan, Yinhui Xu & Shaotao Tang

  2. Department of Computer Science, University of Science and Technology of China, Hefei, China

    Zhong Huang

Authors
  1. Jiangrui Huang
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Zhong Huang
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Hong Mei
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Liying Rong
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Yun Zhou
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Jialing Guo
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Li Wan
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Yinhui Xu
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Shaotao Tang
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Shaotao Tang.

Ethics declarations

Disclosures

Jiang-rui Huang, Zhong Huang, Hong Mei, Li-ying Rong, Yun Zhou, Jia-ling Guo, Li Wan, Yin-hui Xu, and Shao-tao Tang have no conflicts of interest or financial ties to disclose.

Ethical approval

All aspects of this study were approved by the Institutional Committee of Science and Research Ethics (IRB number: 2016-LSZ-S180).

Consent to participate

All patients participating gave written informed consent and authorization for use of data.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Appendices

Appendix

Diagnostic inclusion criteria for four diseases

Choledochal cyst: ① clinical manifestations of the three main symptoms of abdominal pain, jaundice or cystic mass in the right upper abdomen; ② blood biochemical tests with varying degrees of elevation of direct bilirubin, alkaline phosphatase and γ-glutamyl transpeptidase; ③ ultrasound examination suggesting a well-defined hypoechoic area below the liver; ④ magnetic resonance cholangiopancreaticography (MRCP) suggesting common bile duct cystic changes.

Hirschsprung's disease: ① rectal tissue more than 3 cm from the anal dentate line, pathological examination reveals abnormal proliferation of ganglion fiber bundles, but no ganglion cells; ②standing abdominal plain radiographs show low colonic obstruction; ③ barium enema lateral and anterior–posterior photographs show typical spastic and dilated bowel segments with poor barium drainage function. The barium remains after 24 h, and the wall of the dilated intestine is serrated when combined with enteritis; ④ anorectal manometry indicates elevated anorectal pressure.

Vesicoureteral reflux: ① cystourethrography suggesting the presence of voiding reflux, reflux of degree IV or higher, or degree III reflux that has been ineffective with non-surgical treatment and has worsened in degree; ② cavernous ureteral orifice, or paraureteral cystic lesion (Hutch diverticulum); and ③ urinary tract infection not controlled with medication.

Congenital hydronephrosis: ① the presence of clinical symptoms related to hydronephrosis (pain, urinary tract infection) ② ultrasound examination suggesting enlarged renal pelvis and calyces and renal parenchyma thickness > 3 mm; intravenous pyelogram (IVP) suggesting dilated renal pelvis and calyces; ③ radionuclide scan suggesting 30 min after injection of radioactive drugs Radionuclide still does not disappear or no nuclide shows in the affected kidney for 30 min.

Major complications of four diseases

Choledochal cyst:① bile leakage: postoperative bile does not flow into the intestine through the bile-intestinal anastomosis, resulting in bile flowing into the abdominal cavity and retroperitoneum, with clinical manifestations of fever, abdominal pain, and abdominal muscle tension; ② intrahepatic bile duct stones: bile duct epithelium is stimulated, bile duct inflammation and bile stasis cause intrahepatic bile duct stones, with common clinical manifestations of abdominal pain, high fever, chills, and jaundice; ③ anastomotic stenosis: bile duct injury leads to scarring and narrowing of the bile duct lumen, with pathological manifestations of fibrous tissue hyperplasia, thickening of the duct wall, and gradual narrowing of the bile duct lumen.

Hirschsprung’s disease:①anastomotic leak: caused by blood supply or anastomotic tension during resection of megacolon, common clinical manifestations are unexplained abdominal distension, fever, intestinal obstruction, and fecal residue in the drainage tube; ②anastomotic stenosis: the main clinical manifestations are abdominal distension, difficulty in fecal discharge, and narrow anastomosis on finger examination; ③foul feces: a small amount of feces pollutes the underwear when the child passes dilute stool; ④small intestine colitis: clinical manifestations are high fever, The clinical manifestations are high fever, vomiting, diarrhea, obstruction of the intestinal cavity, accumulation of large amounts of intestinal fluid can lead to severe dehydration, acidosis and shock, high mortality, often accompanied by intestinal obstruction, intestinal perforation, malnutrition, delayed development; ⑤ anal incontinence: due to local defects of the sphincter muscle caused by surgical injury, the clinical manifestations are that the child cannot control the bowel movement at will, no fixed number of bowel movements, intestinal peristalsis, feces is discharged from the anus, in severe cases coughing, squatting, walking, sleeping In severe cases, fecal matter or intestinal fluid may flow out when coughing, squatting, walking or sleeping, often accompanied by perianal dampness, erosion, itching or eczema-like changes in the skin around the anus.

Vesicoureteral reflux:①dislodgement of the double J-tube: the double J-tube, which plays the role of support and internal drainage, is dislodged from its functional position, and the clinical manifestations are bladder irritation signs, lumbago, and urinary leakage; ②anastomotic fistula: surgical injury leads to the formation of an abnormal channel between the genitourinary tract, with urinary leakage as the main clinical manifestation, accompanied by vulvar rash, pruritus, and pain.

Congenital hydronephrosis:① hematuria: centrifuged urine precipitated red blood cells ≥ 3/high magnification field, or 1-h non-centrifuged urine red blood cell count ≥ 100,000, or 12-h urine sediment count ≥ 500,000; ② urethral stricture: caused by postoperative urethral epithelial scar healing, with clinical manifestations of urinary difficulty, urinary retention or incontinence, which can seriously affect the erectile function of the penis in male patients.

Rights and permissions

Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Huang, J., Huang, Z., Mei, H. et al. Cost-effectiveness analysis of robot-assisted laparoscopic surgery for complex pediatric surgical conditions. Surg Endosc 37, 8404–8420 (2023). https://doi.org/10.1007/s00464-023-10399-x

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00464-023-10399-x

Keywords

Search

Navigation