Skip to main content
SpringerLink
Log in

Efficacy and cost of robotic hepatectomy: is the robot cost-prohibitive?

  • Original Article
  • Published:
Journal of Robotic Surgery Aims and scope Submit manuscript

Abstract

Robotic technology is being utilized in multiple hepatobiliary procedures, including hepatic resections. The benefits of minimally invasive surgical approaches have been well documented; however, there is some concern that robotic liver surgery may be prohibitively costly and therefore should be limited on this basis. A single-institution, retrospective cohort study was performed of robotic and open liver resections performed for benign and malignant pathologies. Clinical and cost outcomes were analyzed using adjusted generalized linear regression models. Clinical and cost data for 71 robotic (RH) and 88 open (OH) hepatectomies were analyzed. Operative time was significantly longer in the RH group (303 vs. 253 min; p = 0.004). Length of stay was more than 2 days shorter in the RH group (4.2 vs. 6.5 days; p < 0.001). RH perioperative costs were higher ($6026 vs. $5479; p = 0.047); however, postoperative costs were significantly lower, resulting in lower total hospital direct costs compared with OH controls ($14,754 vs. $18,998; p = 0.001). Robotic assistance is safe and effective while performing major and minor liver resections. Despite increased perioperative costs, overall RH direct costs are not greater than OH, the current standard of care.

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

Similar content being viewed by others

References

  1. Jacobs EF, Boris R, Masterson TA (2013) Advances in robotic-assisted radical prostatectomy over time. Prostate Cancer 2013:902686

    Article  PubMed  PubMed Central  Google Scholar 

  2. Heemskerk J, van Gemert WG, Greve JW, Bouvy ND (2007) Robot-assisted versus conventional laparoscopic Nissen fundoplication: a comparative retrospective study on costs and time consumption. Surg Laparosc Endosc Percutan Tech 17(1):1–4

    Article  PubMed  Google Scholar 

  3. Heemskerk J, de Hoog DE, van Gemert WG, Baeten CG, Greve JW, Bouvy ND (2007) Robot-assisted vs. conventional laparoscopic rectopexy for rectal prolapse: a comparative study on costs and time. Dis Colon Rectum 50(11):1825–1830

    Article  PubMed  PubMed Central  Google Scholar 

  4. Wright JD, Kostolias A, Ananth CV, Burke WM, Tergas AI, Prendergast E et al (2014) Comparative effectiveness of robotically assisted compared with laparoscopic adnexal surgery for benign gynecologic disease. Obstet Gynecol 124(5):886–896

    Article  PubMed  PubMed Central  Google Scholar 

  5. Wright JD, Ananth CV, Lewin SN, Burke WM, Lu YS, Neugut AI et al (2013) Robotically assisted vs laparoscopic hysterectomy among women with benign gynecologic disease. JAMA 309(7):689–698

    Article  CAS  PubMed  Google Scholar 

  6. Polignano FM, Quyn AJ, de Figueiredo RS, Henderson NA, Kulli C, Tait IS (2008) Laparoscopic versus open liver segmentectomy: prospective, case-matched, intention-to-treat analysis of clinical outcomes and cost effectiveness. Surg Endosc 22(12):2564–2570

    Article  PubMed  Google Scholar 

  7. Dagher I, Di Giuro G, Dubrez J, Lainas P, Smadja C, Franco D (2009) Laparoscopic versus open right hepatectomy: a comparative study. Am J Surg 198(2):173–177

    Article  PubMed  Google Scholar 

  8. Abu Hilal M, Di Fabio F, Teng MJ, Lykoudis P, Primrose JN, Pearce NW (2011) Single-centre comparative study of laparoscopic versus open right hepatectomy. J Gastrointest Surg 15(5):818–823

    Article  PubMed  Google Scholar 

  9. Nguyen KT, Gamblin TC, Geller DA (2009) World review of laparoscopic liver resection-2,804 patients. Ann Surg 250(5):831–841

    Article  PubMed  Google Scholar 

  10. Buell JF, Cherqui D, Geller DA, O’Rourke N, Iannitti D, Dagher I et al (2009) The international position on laparoscopic liver surgery: the Louisville Statement, 2008. Ann Surg 250(5):825–830

    Article  PubMed  Google Scholar 

  11. Wakabayashi G, Cherqui D, Geller DA, Buell JF, Kaneko H, Han HS et al (2015) Recommendations for laparoscopic liver resection: a report from the second international consensus conference held in Morioka. Ann Surg 261(4):619–629

    PubMed  Google Scholar 

  12. Vigano L, Laurent A, Tayar C, Tomatis M, Ponti A, Cherqui D (2009) The learning curve in laparoscopic liver resection: improved feasibility and reproducibility. Ann Surg 250(5):772–782

    Article  PubMed  Google Scholar 

  13. Kluger MD, Vigano L, Barroso R, Cherqui D (2013) The learning curve in laparoscopic major liver resection. J Hepatobiliary Pancreat Sci 20(2):131–136

    Article  PubMed  Google Scholar 

  14. Cai X, Li Z, Zhang Y, Yu H, Liang X, Jin R et al (2014) Laparoscopic liver resection and the learning curve: a 14-year, single-center experience. Surg Endosc 28(4):1334–1341

    Article  PubMed  Google Scholar 

  15. Leddy L, Lendva T, Satava R (2010) Robotic surgery: applications and cost effectiveness. Open Access Surg 3:99–107

    Article  Google Scholar 

  16. Ji WB, Wang HG, Zhao ZM, Duan WD, Lu F, Dong JH (2011) Robotic-assisted laparoscopic anatomic hepatectomy in China: initial experience. Ann Surg 253(2):342–348

    Article  PubMed  Google Scholar 

  17. Idrees K, Bartlett DL (2010) Robotic liver surgery. Surg Clin N Am 90(4):761–774

    Article  PubMed  Google Scholar 

  18. Giulianotti PC, Sbrana F, Coratti A, Bianco FM, Addeo P, Buchs NC et al (2011) Totally robotic right hepatectomy: surgical technique and outcomes. Arch Surg 146(7):844–850

    Article  PubMed  Google Scholar 

  19. Giulianotti PC, Coratti A, Sbrana F, Addeo P, Bianco FM, Buchs NC et al (2011) Robotic liver surgery: results for 70 resections. Surgery 149(1):29–39

    Article  PubMed  Google Scholar 

  20. Park BJ, Flores RM (2008) Cost comparison of robotic, video-assisted thoracic surgery and thoracotomy approaches to pulmonary lobectomy. Thorac Surg Clin 18(3):297–300

    Article  PubMed  Google Scholar 

  21. Morgan JA, Thornton BA, Peacock JC, Hollingsworth KW, Smith CR, Oz MC et al (2005) Does robotic technology make minimally invasive cardiac surgery too expensive? A hospital cost analysis of robotic and conventional techniques. J Cardiac Surg 20(3):246–251

    Article  Google Scholar 

  22. Martin AD, Nunez RN, Castle EP (2011) Robot-assisted radical cystectomy versus open radical cystectomy: a complete cost analysis. Urology 77(3):621–625

    Article  PubMed  Google Scholar 

  23. Hohwu L, Borre M, Ehlers L, Venborg Pedersen K (2011) A short-term cost-effectiveness study comparing robot-assisted laparoscopic and open retropubic radical prostatectomy. J Med Econ 14(4):403–409

    Article  PubMed  Google Scholar 

  24. Kaye DR, Mullins JK, Carter HB, Bivalacqua TJ (2015) Robotic surgery in urological oncology: patient care or market share? Nat Rev Urol 12:55–60

    Article  PubMed  Google Scholar 

  25. Castaing D, Vibert E, Ricca L, Azoulay D, Adam R, Gayet B (2009) Oncologic results of laparoscopic versus open hepatectomy for colorectal liver metastases in two specialized centers. Ann Surg 250(5):849–855

    Article  PubMed  Google Scholar 

  26. Dindo D, Demartines N, Clavien PA (2004) Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg 240(2):205–213

    Article  PubMed  PubMed Central  Google Scholar 

  27. CDC (2015) Defining adult overweight and obesity. http://www.cdc.gov/obesity/adult/defining.html (cited 20 Sept 2015)

  28. Dripps RD (1963) New classification of physical status. Anesthesiology 24:111

    Google Scholar 

  29. Herron DM, Marohn M, Group S-MRSC (2008) A consensus document on robotic surgery. Surg Endosc 22(2):313–325 (discussion 1–2)

    Article  CAS  PubMed  Google Scholar 

  30. Yu YD, Kim KH, Jung DH, Namkoong JM, Yoon SY, Jung SW et al (2014) Robotic versus laparoscopic liver resection: a comparative study from a single center. Langenbeck’s Arch Surg 399(8):1039–1045

    Article  Google Scholar 

  31. Tsung A, Geller DA, Sukato DC, Sabbaghian S, Tohme S, Steel J et al (2014) Robotic versus laparoscopic hepatectomy: a matched comparison. Ann Surg 259(3):549–555

    Article  PubMed  Google Scholar 

  32. Tranchart H, Ceribelli C, Ferretti S, Dagher I, Patriti A (2014) Traditional versus robot-assisted full laparoscopic liver resection: a matched-pair comparative study. World J Surg 38(11):2904–2909

    Article  PubMed  Google Scholar 

  33. Spampinato MG, Coratti A, Bianco L, Caniglia F, Laurenzi A, Puleo F et al (2014) Perioperative outcomes of laparoscopic and robot-assisted major hepatectomies: an Italian multi-institutional comparative study. Surg Endosc 28(10):2973–2979

    Article  PubMed  Google Scholar 

  34. Clinical Outcomes of Surgical Therapy Study Group (2004) A comparison of laparoscopically assisted and open colectomy for colon cancer. N Engl J Med 350(20):2050–2059

    Article  Google Scholar 

  35. Cai XJ, Yang J, Yu H, Liang X, Wang YF, Zhu ZY et al (2008) Clinical study of laparoscopic versus open hepatectomy for malignant liver tumors. Surg Endosc 22(11):2350–2356

    Article  PubMed  Google Scholar 

  36. Ocuin LM, Tsung A (2015) Robotic liver resection for malignancy: current status, oncologic outcomes, comparison to laparoscopy, and future applications. J Surg Oncol 112(3):295–301

    Article  PubMed  Google Scholar 

  37. Barbash GI, Glied SA (2010) New technology and health care costs—the case of robot-assisted surgery. N Engl J Med 363(8):701–704

    Article  CAS  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Surgery, Center for Advanced Minimally Invasive Liver Oncologic Therapies (CAMILOT), University of Washington, 1959 Pacific St NE, Seattle, WA, 98195, USA

    Jonathan G. Sham, Morgan K. Richards, Y. David Seo, Venu G. Pillarisetty, Raymond S. Yeung & James O. Park

Authors
  1. Jonathan G. Sham
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Morgan K. Richards
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Y. David Seo
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Venu G. Pillarisetty
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Raymond S. Yeung
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. James O. Park
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Jonathan G. Sham.

Ethics declarations

Conflict of interest

All authors declare that they have no conflict of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed consent

Informed consent was not obtained from individual participants included in the study as allowed by our institutional review board in the setting of retrospective reviews/de-identified clinical data.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Sham, J.G., Richards, M.K., Seo, Y.D. et al. Efficacy and cost of robotic hepatectomy: is the robot cost-prohibitive?. J Robotic Surg 10, 307–313 (2016). https://doi.org/10.1007/s11701-016-0598-4

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11701-016-0598-4

Keywords

Search

Navigation