Single‐site robotic cholecystectomy: efficiency and cost analysis

Buzad, Francis A.; Corne, Louis M.; Brown, Thomas C.; Fagin, Randy; Slee, April; Kaczmarek, C; Pack, Angie N.; Payne, Thomas N.

doi:10.1002/rcs.1507

Cited by 49 publications

(39 citation statements)

References 25 publications

(42 reference statements)

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“…Surgeon reputation is therefore a key but under-recognized factor driving episodes of surgical care (18), probably second only to the effort expended by the surgeon during the procedure. One of the major factors limiting the number of cases performed by a surgeon in a day is the duration of conventional open or laparoscopic procedures spent in ergonomically uncomfortable positions (19). Vidovszky et al suggested that the ergonomics of robotic surgery diminishes fatigue and reduces surgeon injuries relative to long hours holding laparoscopic instruments in unsupported positions (20).…”

Section: The Surgeon Value Propositionmentioning

confidence: 99%

“…Buzad and colleagues compared robotic vs. laparoscopic cholecystectomies at a single institution and analyzed operating room times, case volume, and instrument costs excluding amortization of the robot, utilities, and yearly maintenance (19). While operative times and instrument costs were similar ($1,325 versus $1,145), the robotic technique allowed that facility to perform a higher number of cholecystectomies per operative day.…”

Section: Rcmentioning

confidence: 99%

“…Four analyzed direct hospital costs (42-45) while one measured top-down costs (46) and one measured instrument costs (19). Two of the four hospital cost analyses demonstrated increased hospital costs of at least $1,900 (42,43).…”

Section: Analysis Of Rcmentioning

confidence: 99%

“…The top down analysis found a minimum additional cost of $2,600 per procedure (43) while the instrument price examination found equal instrument costs (19). Two studies found no significant difference (19,44) or minor savings of $391 dollars (45).…”

Section: Analysis Of Rcmentioning

confidence: 99%

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Value-based assessment of robotic pancreas and liver surgery

Patti

Ore

Barrows

et al. 2017

Hepatobiliary Surg. Nutr.

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Current healthcare economic evaluations are based only on the perspective of a single stakeholder to the healthcare delivery process. A true value-based decision incorporates all of the outcomes that could be impacted by a single episode of surgical care. We define the value proposition for robotic surgery using a stakeholder model incorporating the interests of all groups participating in the provision of healthcare services: patients, surgeons, hospitals and payers. One of the developing and expanding fields that could benefit the most from a complete value-based analysis is robotic hepatopancreaticobiliary (HPB) surgery. While initial robot purchasing costs are high, the benefits over laparoscopic surgery are considerable. Performing a literature search we found a total of 18 economic evaluations for robotic HPB surgery. We found a lack of evaluations that were carried out from a perspective that incorporates all of the impacts of a single episode of surgical care and that included a comprehensive hospital cost assessment. For distal pancreatectomies, the two most thorough examinations came to conflicting results regarding total cost savings compared to laparoscopic approaches. The most thorough pancreaticoduodenectomy evaluation found non-significant savings for total hospital costs. Robotic hepatectomies showed no cost savings over laparoscopic and only modest savings over open techniques. Lastly, robotic cholecystectomies were found to be more expensive than the gold-standard laparoscopic approach. Existing cost accounting data associated with robotic HPB surgery is incomplete and unlikely to reflect the state of this field in the future. Current data combines the learning curves for new surgical procedures being undertaken by HPB surgeons with costs derived from a market dominated by a single supplier of robotic instruments. As a result, the value proposition for stakeholders in this process cannot be defined. In order to solve this problem, future studies must incorporate (I) quality of life, survival, and return to independent function alongside data such as (II) intent-to-treat analysis of minimally-invasive surgery accounting for conversions to open, (III) surgeon and institution experience and operative time as surrogates for the learning curve; and (IV) amortization and maintenance costs as well as direct costs of disposables and instruments.

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Section: The Surgeon Value Propositionmentioning

confidence: 99%

Section: Rcmentioning

confidence: 99%

Section: Analysis Of Rcmentioning

confidence: 99%

Section: Analysis Of Rcmentioning

confidence: 99%

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Value-based assessment of robotic pancreas and liver surgery

Patti

Ore

Barrows

et al. 2017

Hepatobiliary Surg. Nutr.

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“…Buzad и соавт. (2013) не выявили статисти-чески значимых различий в оперативном времени между робот-ассистированной ЛХЭ и ТЛХЭ -84,6 и 85,5 мин соответственно (p=0,8737), потери крови и осложнения были минимальными, материальные затраты эквивалентны [60].…”

Section: рис 4 система Endosamurai для управления ин-струментами с unclassified

Cholecystectomy: evolution of laparoscopic approach

Михин¹,

Kuhktenko²,

Доронин³

2015

Endosk. khir.

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Single‐site robotic cholecystectomy versus single‐incision laparoscopic cholecystectomy: A systematic review and meta‐analysis

Rudiman

Hanafi

Almawijaya

2023

Annals of Gastroent Surgery

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BackgroundThe possibilities of minimally invasive cholecystectomy have emerged since the beginning of single‐incision laparoscopic cholecystectomy (SILC) and single‐site robotic cholecystectomy (SSRC). This study aimed to compare the feasibility, safety, and pain scores between SSRC and SILC.MethodsThe authors searched randomized or non‐randomized controlled trials and observational studies in PubMed, EuroPMC, and ClinicalTrials.gov from April 2012 until April 2022. The authors analyzed the operation time, hospital stay, blood loss volume, conversion rate, intraoperative complication rates, postoperative complications, visual analog scale (VAS) immediately after surgery, and VAS at hospital discharge. This study aligned with PRISMA and AMSTAR guidelines.ResultsThirteen studies were selected with 817 and 757 patients who underwent SSRC and SILC. Thus, this study demonstrated a lower incidence of intraoperative complication rates [relative risk (RR) 0.57 (95% CI 0.34–0.96), p = 0.03] and lesser VAS score at hospital discharge [Std. Mean Difference (SMD) −0.23 (95% CI −0.46, −0.01), p = 0.04] in the SSRC group. Regarding operation time and cost, SSRC revealed a longer time [SMD 1.02 (95% CI 0.45, 1.59), p = 0.0004] and higher cost [SMD 4.18 (95% CI 1.77, 6.58), p < 0.00001], respectively. Meanwhile, SSRC did not differ from SILC during a hospital stay, blood loss volume, conversion rate, postoperative complication rates, and VAS immediately after surgery.ConclusionsConcerning intraoperative complication rates and VAS score at hospital discharge, SSRC was superior to SILC. Thus, SSRC is considered a feasible and safe procedure.

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Single‐site robotic cholecystectomy: efficiency and cost analysis

Abstract: Robotic single-site cholecystectomy is a safe, cost-effective alternative to single-incision laparoscopic cholecystectomy in a robot-existing model.

Cited by 49 publications

References 25 publications

Value-based assessment of robotic pancreas and liver surgery

Value-based assessment of robotic pancreas and liver surgery

Cholecystectomy: evolution of laparoscopic approach

Single‐site robotic cholecystectomy versus single‐incision laparoscopic cholecystectomy: A systematic review and meta‐analysis

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