Robotic-Assisted Versus Laparoscopic Incisional Hernia Repair: Differences in Direct Costs From a Brazilian Public Institute Perspective

Abstract

BACKGROUND: Robotic-assisted surgery research has grown dramatically in the past two decades and the advantages over traditional videolaparoscopy have been extensively debated. For hernias, the robotic system can increase intraoperative strategies, especially in complex hernias or incisional hernias. AIMS: This study aimed to compare the direct cost differences between robotic and laparoscopic hernia repair and determine each source of expenditure that may be related to the increased costs in a robotic program from the perspective of a Brazilian public institution. METHODS: This study investigated the differences in direct costs from the data generated from a trial protocol (ReBEC: RBR-5s6mnrf). Patients with incisional hernia were randomly assigned to receive laparoscopic ventral incisional hernia repair (LVIHR) or robotic ventral incisional hernia repair (RVIHR). The direct medical costs of hernia treatment were described in the Brazilian currency (R$). RESULTS: A total of 19 patients submitted to LVIHR were compared with 18 submitted to RVIHR. The amount spent on operation room time (RVIHR: 2,447.91±644.79; LVIHR: 1,989.67±763.00; p=0.030), inhaled medical gases in operating room (RVIHR: 270.57±211.51; LVIHR: 84.55±252.34; p=0.023), human resources in operating room (RVIHR: 3,164.43±894.97; LVIHR: 2,120.16±663.78; p<0.001), material resources (RVIHR: 3,204.32±351.55; LVIHR: 736.51±972.32; p<0.001), and medications (RVIHR: 823.40±175.47; LVIHR: 288.50±352.55; p<0.001) for RVIHR was higher than that for LVIHR, implying a higher total cost to RVIHR (RVIHR: 14,712.24±3,520.82; LVIHR: 10,295.95±3,453.59; p<0.001). No significant difference was noted in costs related to the hospital stay, human resources in intensive care unit and ward, diagnostic tests, and meshes. CONCLUSION: Robotic system adds a significant overall cost to traditional laparoscopic hernia repair. The cost of the medical and robotic devices and longer operative times are the main factors driving the difference in costs.

Umbilical and Epigastric Hernia Repair: A Systematic Review

“…After the exclusion of duplicates and the application of inclusion and exclusion criteria, 15 RCTs were selected. The European Hernia Society and the Americas Hernia Society Guidelines and Costa et al 7 study were also included in the discussion as mentioned above 7 , 9 .…”

“…Robotic-assisted surgery research has grown in the past two decades in abdominal hernias and the advantages over traditional videolaparoscopy have been debated. Costa et al analyzed the costs of a robotic program in a Brazilian public institution to treat abdominal hernias and concluded that the robotic system can increase intraoperative strategies, especially in complex hernias or incisional hernias, however, it adds a significant overall cost to traditional laparoscopic hernia repair, especially umbilical and epigastric hernias 7 .…”

“…The European Hernia Society and the Americas Hernia Society Guidelines for treatment of umbilical and epigastric hernias and Costa et al 7 study (even though they were studies with criteria outside those established in the search strategy of this systematic review) were included to compare and complement some topics not approached by the selected RCTs, as well as improve and expand the discussion of topics related to the treatment of umbilical and epigastric hernias 7 , 9 .…”

Stapled Fascial Closure vs. Continuous Hand-Sewn Suture: Experimental Study of the Abdominal Wall on Porcine Model and Human Cadaver

“…Despite the growing popularity of minimally invasive approaches in abdominal surgery, it is unlikely that the open approach will ever entirely disappear from the surgical landscape. Minimally invasive techniques, such as laparoscopy and robotic-assisted surgery, have indeed revolutionized many procedures, offering benefits such as less pain, shorter hospital stays, and faster recovery times 6 , 7 , 10 , 12 , 24 , 29 . However, the open approach continues to hold a crucial role, particularly in challenging cases that demand wide exposure.…”

Meta-analysis of the effectiveness and safety of robotic-assisted versus laparoscopic transabdominal preperitoneal repair for inguinal hernia

“…With its unique features, including 3D imaging, a mechanical arm with 7 degrees of freedom, tremor filtration, and more ergonomic design, da Vinci surgery has elevated surgical precision to unprecedented heights and ushered minimally invasive surgery into a new era [7,8]. Currently, it has been successfully applied in abdominal wall incisional hernia repair, paraesophageal hernia repair, and inguinal hernia repair, demonstrating its technical advantages [9][10][11]. While several randomized controlled studies and nonrandomized controlled studies have compared RTAPP with LTAPP in the treatment of inguinal hernia [12][13][14][15][16][17][18][19][20][21], there is limited data from single-center studies, and clinical reports yield inconsistent results.…”