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Operating costs, fiscal impact, value analysis and guidance for the routine use of robotic technology in abdominal surgical procedures

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Abstract

Background

This study was designed to define the value, cost, and fiscal impact of robotic-assisted procedures in abdominal surgery and provide clinical guidance for its routine use.

Methods

34,984 patients who underwent an elective cholecystectomy, colectomy, inguinal hernia repair, hysterectomy, or appendectomy over a 24-month period were analyzed by age, BMI, risk class, operating time, LOS and readmission rate. Average Direct and Total Cost per Case (ADC, TCC) and Net Margin per Case (NM) were produced for each surgical technique, i.e., open, laparoscopic, and robotic assisted (RA).

Results

All techniques were shown to have similar clinical outcomes. 9412 inguinal herniorrhaphy were performed (48% open with $2138 ADC, 29% laparoscopy with $3468 ADC, 23% RA with $6880 ADC); 8316 cholecystectomies (94% laparoscopy with $2846 ADC, 4.4% RA with a $7139 ADC, 16% open with a $3931 ADC); 3432 colectomies (42% open with a $12,849 ADC, 38% laparoscopy with a $10,714, 20% RA with a $15,133); 12,614 hysterectomies [42% RA with a $8213 Outpatient (OP) ADC, 39% laparoscopy $5181 OP ADC, 19% open $4894 OP ADC]. Average Global NM is − 1% for RA procedures and only positive with commercial payors.

Conclusion

RA techniques do not produce significant clinical enhancements than similar surgical techniques with identical outcomes while their costs are much higher. The produced value analysis does not support the routine use of RA techniques for inguinal hernia repair and cholecystectomy. RA techniques for hysterectomies and colectomies are also performed at much higher cost than open and laparoscopic techniques, should only be routinely used with appropriate clinical justification and by cost efficient surgical providers.

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References

  1. Gkegkes ID, Mamais IA, Iavazzo C (2017) Robotics in general surgery: a systematic cost assessment. J Minim Access Surg 13(4):243–255

    Article  Google Scholar 

  2. Khorgami Z, Li WT, Jackson TN, Anthony Howard C, Sclabas GM (2019) The cost of robotics: an analysis of the added costs of robotic-assisted versus laparoscopic surgery using the National Inpatient Sample. Surg Endosc 33(7):2217–2221

    Article  Google Scholar 

  3. Higgins RM, Frelich MJ, Bosler ME, Gould JC (2017) Cost analysis of robotic versus laparoscopic general surgery procedures. Surg Endosc 31(1):185–192

    Article  Google Scholar 

  4. National Institute for Health and Care Excellence (2015) Developing NICE Guidelines: the manual. Process and Methods Guides No. 20. National Institute for Health and Care Excellence (NICE), London

  5. Quilici PJ, Greaney EM Jr, Quilici J, Anderson S (2000) Laparoscopic inguinal hernia repair: optimal technical variations and results in 1700 cases. Am Surg 66(9):848–852

    CAS  PubMed  Google Scholar 

  6. Dirksen CD, Beets GL, Go PMNYH et al (1998) Bassini repair compared with laparoscopic repair for primary inguinal hernia: a randomized controlled trial. Eur J Surg 164:439–447

    Article  CAS  Google Scholar 

  7. James G, Bittner IV, Cesnik LW, Kirwan T, Wolf L, Guo D (2018) Patient perceptions of acute pain and activity disruption following inguinal hernia repair: a propensity-matched comparison of robotic-assisted, laparoscopic, and open approaches. J Robot Surg 12(4):625–632

    Article  Google Scholar 

  8. Pirolla EH, Patriota GP, Pirolla FJC, Ribeiro FPG, Rodrigues MG, Ismail LR, Ruano RM (2018) Inguinal hernia repair via robotic-assisted technique: a literature review. Arq Bras Cir Dig 31(4):e1408

    Article  Google Scholar 

  9. Saito T, Fukami Y, Uchino T, Kurahashi S, Matsumura T, Osawa T, Arikawa T, Komatsu S, Kaneko K, Sano T (2020) Preliminary results of robotic inguinal hernia repair following its introduction in a single-center trial. Ann Gastroenterol Surg 4(4):441–447

    Article  Google Scholar 

  10. The HerniaSurge Group (2018) International guidelines for groin hernia management. Hernia 22(1):1–165

    Article  Google Scholar 

  11. Pedroso LM, de-Melo RM, da-Silva-JR NJ (2017) Comparative study of postoperative pain between the lichtenstein and laparoscopy surgical techniques for the treatment of unilateral primary inguinal hernia. Arq Bras Cir Dig 30(3):173–176

    Article  Google Scholar 

  12. Reiner MA, Bresnahan ER (2016) Laparoscopic total extraperitoneal hernia repair outcomes. JSLS 20(3):e2016.00043

    Article  Google Scholar 

  13. Podolsky D, Novitsky Y (2020) Robotic inguinal hernia repair. Surg Clin North Am 100(2):409–415

    Article  Google Scholar 

  14. Abdelmoaty WF, Dunst CM, Neighorn C, Swanstrom LL, Hammill CW (2019) Robotic-assisted versus laparoscopic unilateral inguinal hernia repair: a comprehensive cost analysis. Surg Endosc 33(10):3436–3443

    Article  Google Scholar 

  15. Miguel PR, Reusch M, daRosa ALM, Carlos JRB (1998) Laparoscopic hernia repair—complications. JSLS 2(1):35–40

    CAS  PubMed  PubMed Central  Google Scholar 

  16. Khoraki J et al (2020) Perioperative outcomes and cost of robotic-assisted versus laparoscopic inguinal hernia repair. Surg Endosc 34(8):3496–3507

    Article  Google Scholar 

  17. Sheetz KH, Claflin J, Dimick JB (2020) Trends in the adoption of robotic surgery for common surgical procedures. JAMA Netw Open 3(1):e1918911

    Article  Google Scholar 

  18. Nolan H, Glenn J (2018) Minimally invasive pediatric cholecystectomy: a comparison of robotic and laparoscopic single and multiport techniques. J Laparoendosc Adv Surg Tech A 28(6):770–773

    Article  Google Scholar 

  19. Huang Y, Chua TC, Maddern GJ, Samra JS (2017) Robotic cholecystectomy versus conventional laparoscopic cholecystectomy: a meta-analysis. Surgery 161(3):628–636

    Article  Google Scholar 

  20. Rosemurgy A, Ryan C, Klein R, Sukharamwala P, Wood T, Ross S (2015) Does the cost of robotic cholecystectomy translate to a financial burden? Surg Endosc 29(8):2115–2120

    Article  Google Scholar 

  21. Sheetz KH, Norton EC, Dimick JB, Regenbogen SE (2019) Perioperative outcomes and trends in the use of robotic colectomy for medicare beneficiaries from 2010 through 2016. JAMA Surg 155(1):41–49

    Article  Google Scholar 

  22. Yeo HL, Isaacs AJ, Abelson JS, Milsom JW, Sedrakyan A (2016) Comparison of open, laparoscopic, and robotic colectomies using a large national database: outcomes and trends related to surgery center volume. Dis Colon Rectum 59(6):535–542

    Article  Google Scholar 

  23. Sivathondan PC, Fellow C, Unit JGC, Leeds DGJ (2018) The role of robotics in colorectal surgery. Ann R Coll Surg Engl 100(Suppl 7):42–53

    Article  CAS  Google Scholar 

  24. Zelhart M, Kaiser AM (2018) Robotic versus laparoscopic versus open colorectal surgery: towards defining criteria to the right choice. Surg Endosc 32(1):24–38

    Article  Google Scholar 

  25. Papanikolaou IG (2014) Robotic surgery for colorectal cancer: systematic review of the literature. Surg Laparosc Endosc Percutan Tech 24(6):478–483

    Article  Google Scholar 

  26. Moghadamyeghaneh Z et al (2016) Comparison of open, laparoscopic, and robotic approaches for total abdominal colectomy. Surg Endosc 30(7):2792–2798

    Article  Google Scholar 

  27. Bastawrous A, Baer C, Rashid L, Neighorn C (2018) Higher robotic colorectal surgery volume improves outcomes. Am J Surg 215:874–878

    Article  CAS  Google Scholar 

  28. Rashidi L, Neighorn C, Bastawrous A (2017) Outcome comparisons between high-volume robotic and laparoscopic surgeons in a large healthcare system. Am J Surg 213:901–905

    Article  Google Scholar 

  29. Ji-Chan Nie MD, An-Qi Yan MD, Xi-Shi Liu MD (2017) Robotic-assisted radical hysterectomy results in better surgical outcomes compared with the traditional laparoscopic radical hysterectomy for the treatment of cervical cancer. Int J Gynecol Cancer 27(9):1990–1999

    Article  Google Scholar 

  30. Kimmig R, Ind T (2018) Minimally invasive surgery for cervical cancer: consequences for treatment after LACC Study. J Gynecol Oncol 29(4):e75

    Article  Google Scholar 

  31. Pennington KP, Urban RR, Gray HJ (2019) Revisiting minimally invasive surgery in the management of early-stage cervical cancer. J Natl Compr Canc Netw 17(1):86–90

    Article  Google Scholar 

  32. Qin M, Siyi Li, Huang H-F, Yan Li YuGu, Wang W, Shan Y, Yin J, Wang Y-X, Cai Y, Chen J-Y, Jin Y, Ling-Ya Pan A (2020) Comparison of laparoscopies and laparotomies for radical hysterectomy in stage IA1–IB1 cervical cancer patients: a single team with 18 years of experience. Front Oncol 10:1738

    Article  Google Scholar 

  33. Yuan Z, Cao D, Yang J, Yu M, Shen K, Yang J, Zhang Y, Zhou H (2019) Laparoscopic vs. open abdominal radical hysterectomy for cervical cancer: a single-institution, propensity score matching study in China. Front Oncol 9:1107

    Article  Google Scholar 

  34. Varghese A, Doglioli M, Fader AN (2019) Updates and controversies of robotic-assisted surgery in gynecologic surgery. Clin Obstet Gynecol 62(4):733–748

    Article  Google Scholar 

  35. Clair KH, Tewari KS (2020) Robotic surgery for gynecologic cancers: indications, techniques and controversies. J Obstet Gynaecol Res 46(6):828–843

    Article  Google Scholar 

  36. Wright JD, Cham S, Chen L, Burke WM, Hou JY, Tergas AI, Desai V, Hu JC, Ananth CV, Neugut AI, Hershman DL (2017) Utilization of sentinel lymph node biopsy for uterine cancer. Am J Obstet Gynecol 216(6):594.e1-594.e13

    Article  Google Scholar 

  37. Iavazzo C, Papadopoulou EK, Gkegkes ID (2014) Cost assessment of robotics in gynecologic surgery: a systematic review. J Obstet Gynaecol Res 40(11):2125–2134

    Article  Google Scholar 

  38. 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(1):92–96

    Article  Google Scholar 

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Authors and Affiliations

  1. PSJH System Digestive Health Institute, Renton, WA, USA

    Philippe J. Quilici

  2. PSJMC MIS-Ba Service, Burbank, CA, USA

    Philippe J. Quilici

  3. PSJH Clinical Analytics, Renton, WA, USA

    Harry Wolberg

  4. PSJH Finance Institute, Renton, WA, USA

    Nathaniel McConnell

Authors
  1. Philippe J. Quilici
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  2. Harry Wolberg
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  3. Nathaniel McConnell
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Correspondence to Philippe J. Quilici.

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The authors, Dr. P J. Quilici, Mr. Harry Wolberg and Mr. Nathaniel McConnell have no conflict of interest or financial ties to disclose.

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Quilici, P.J., Wolberg, H. & McConnell, N. Operating costs, fiscal impact, value analysis and guidance for the routine use of robotic technology in abdominal surgical procedures. Surg Endosc 36, 1433–1443 (2022). https://doi.org/10.1007/s00464-021-08428-8

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  • DOI: https://doi.org/10.1007/s00464-021-08428-8

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