Comparative health technology assessment of robotic-assisted, direct manual laparoscopic and open surgery: a prospective study (original) (raw)
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Introduction: Health Technology Assessment (HTA) is a systematic multidisciplinary activity which assesses application of health technology. Surgical robots provides an improved 3D view of surgical area and a better manipulation of surgical arms as compared to conventional laparoscopic surgery. Objective of the study is to perform Cost benefit analysis of robotic surgery (RS). Originality: Original research work Materials and methods: A retrospective cross sectional study was done for a period of 2 months. 50 robotic and 40 open surgical cases were selected. Direct & indirect costs of care were estimated along with assessment of operational costs for RS. Statistical analysis was performed. Correlation of length of stay (LOS) was done with direct and indirect costs incurred. Results: Robotic surgery is a high end CapEx model but financially viable. A positive NPV was seen with ROI in the 5th year. Operational cost and material cost were found to be statistically higher for RS. Pharmacy cost and nursing cost showed a high degree of correlation with LOS in gynaecological oncology department. Reduced LOS, less pain and faster recovery are the major positive impact that harbinger the socioeconomic benefit. Surgeons too have greater visualization and dexterity. RS provides better patient care by shortening recovery period and post-operative care. Conclusion: HTA is ‘a bridge’ between evidence and policy-making. It guides decision-makers about appropriate use of technology and efficient allocation of resources. RS is an advanced approach which significantly improves patient care and provides more flexibility and precision to surgeons. Keywords: HTA, robot, decision-making
Research Square (Research Square), 2024
Background Hysterectomy for benign pathologies is one of the most common gynecological surgeries. In recent years, robotic surgery has become an alternative to traditional surgery, but at a higher cost. Objective Estimate the cost of benign robot-assisted hysterectomy for the purpose of supporting public decisionmaking, as well as the additional cost per major postoperative complication (ClavienDindo score ≥ 3) avoided one month after surgery robotic versus traditional laparoscopic. Methods Single-center retrospective study including patients operated on for benign hysterectomy at La Pitié Salpêtrière hospital between January 2016 and December 2019 : 99 by robotic approach, and 86 by laparoscopic approach. Comparison of robotic surgery to laparoscopy. Calculation of a costeffectiveness ratio (ICER). Use of the propensity score inverse weighting method to ensure comparability of groups. Results Robotic surgery has a total cost of € 6,615 at 1 month per patient compared to € 3,859 for laparoscopic surgery with an additional cost of € 377,534 per major postoperative complication avoided, longer operating time and an absence of signi cant difference in terms of complications and length of hospitalization. Conclusion In terms of cost-effectiveness, according to this study, the robot does not appear to be better than laparoscopy. In the years to come, we can expect a development of robotic surgery with rationalization of the practice, with appropriate selection of patients for robotic surgery, development of outpatient surgery and a reduction in the cost of the equipment.
Health Policy and Technology, 2020
Objectives: Some hospitals have invested in robotic surgery platforms to stimulate the uptake of minimally invasive surgery (MIS) and offer its benefits to more patients. The objectives were to determine the clinical and financial effects, as well as the policy implications, of a robotics program in an academic gynecologic oncology division over time. Methods: Patients treated for endometrial, cervical, and ovarian cancer within a gyn-oncology division between 2003 and 2016 were included in the current study. Clinical outcomes were described in function of surgical approach (laparotomy, laparoscopy, and robotic surgery) and tumor site. The net present value and the return on investment of the robotics program were approximated using previously reported treatment costs from our center. Results: The use of MIS soared from a high of 15% to 91% before and after the introduction of robotics in December 2007, respectively. Across all tumor sites, MIS procedures were associated with diminished blood loss and a shorter hospital stay (p < 0.0 0 01). The use of robotics in gyn-oncology resulted in cost savings. Conclusions: Robotic surgery was instrumental in catalyzing the shift from open surgery to MIS and amplifying the number of patients who benefited from less invasive surgery. Continued investments in robotics and the digitization of surgery could help further drive innovation and expand its applications.
Frontiers in Surgery
BackgroundThe studies which address the impact of costs of robotic vs. laparoscopic approach on quality of life (cost-effectiveness studies) are scares in general surgery.MethodsThe Spanish national study on cost-effectiveness differences among robotic and laparoscopic surgery (ROBOCOSTES) is designed as a prospective, multicentre, national, observational study. The aim is to determine in which procedures robotic surgery is more cost-effective than laparoscopic surgery. Several surgical operations and patient populations will be evaluated (distal pancreatectomy, gastrectomy, sleeve gastrectomy, inguinal hernioplasty, rectal resection for cancer, Heller cardiomiotomy and Nissen procedure).DiscussionThe results of this study will demonstrate which treatment (laparoscopic or robotic) and in which population is more cost-effective. This study will also assess the impact of previous surgical experience on main outcomes.
Advantages and limits of robot-assisted laparoscopic surgery: preliminary experience
Surgical Endoscopy, 2005
Background: In the last few years, robotics has been applied in clinical practice for a variety of laparoscopic procedures. This study reports our preliminary experience using robotics in the field of general surgery to evaluate the advantages and limitations of robotassisted laparoscopy. Methods: Thirty-two consecutive patients were scheduled to undergo robot-assisted laparoscopic surgery in our units from March 2002 to July 2003. The indications were cholecystectomy, 20 patients; right adrenalectomy, two points; bilateral varicocelectomy, two points; Heller's cardiomyotomy, two points; Nissen's fundoplication, two points; total splenectomy, one point; right colectomy, one point; left colectomy, 1 point; and bilateral inguinal hernia repair, one point. In all cases, we used the da Vinci surgical system, with the surgeon at the robotic work station and an assistant by the operating table.
Robotics in general surgery: A systematic cost assessment
Journal of Minimal Access Surgery, 2017
The utilisation of robotic-assisted techniques is a novelty in the field of general surgery. Our intention was to examine the up to date available literature on the cost assessment of robotic surgery of diverse operations in general surgery. PubMed and Scopus databases were searched in a systematic way to retrieve the included studies in our review. Thirty-one studies were retrieved, referring on a vast range of surgical operations. The mean cost for robotic, open and laparoscopic ranged from 2539 to 57,002, 7888 to 16,851 and 1799 to 50,408 Euros, respectively. The mean operative charges ranged from 273.74 to 13,670 Euros. More specifically, for the robotic and laparoscopic gastric fundoplication, the cost ranged from 1534 to 2257 and 657 to 763 Euros, respectively. For the robotic and laparoscopic colectomy, it ranged from 3739 to 17,080 and 3109 to 33,865 Euros, respectively. For the robotic and laparoscopic cholecystectomy, ranged from 1163.75 to 1291 and from 273.74 to 1223 Euros, respectively. The mean non-operative costs ranged from 900 to 48,796 from 8347 to 8800 and from 870 to 42,055 Euros, for robotic, open and laparoscopic technique, respectively. Conversions to laparotomy were present in 34/18,620 (0.18%) cases of laparoscopic and in 22/1488 (1.5%) cases of robotic technique. Duration of surgery robotic, open and laparoscopic ranged from 54.6 to 328.7, 129 to 234, and from 50.2 to 260 min, respectively. The present evidence reveals that robotic surgery, under specific conditions, has the potential to become cost-effective. Large number of cases, presence
Laparoscopic, Endoscopic and Robotic Surgery, 2018
Aim: The goal of this research was to create a mathematical model to evaluate the short-term effectiveness of laparoscopic and robotic surgeries and to apply this model to surgeries with laparoscopic and robotic variants to evaluate their performances. Materials and methods: A mathematical model was developed in this study to compare the short-term effectiveness of six different surgical procedures: Ventral Hernia Repairs, Hysterectomies, Lung Lobectomies, Pancreatectomies, Gastric Bypass, and Prostatectomies. The criteria analyzed to compare these procedures included operative time, cost, length of hospitalization, readmission rate, morbidity rate, and mortality rate. These criteria were scaled based on their significance when considering a surgery, such that more important criteria, those that directly impact patient health, are more heavily weighted than less important criteria. Results: The mathematical model indicated that robotic surgery was the preferred option for lung lobectomies and prostatectomies. Laparoscopy was preferred for all other procedures. In the case of gastric bypass, laparoscopy was heavily preferred, and there was only a marginal preference in laparoscopy for hysterectomies and ventral hernia repairs. Conclusion: The mathematical model developed in this research serves as a robust definitive standard that can continue to be utilized to compare robotic and laparoscopic surgeries. With new technologies, preferences are likely to change in favor of robotic surgery, and this model can be employed to predict the impact of those advancements.
The Future of Robotic-Assisted Laparoscopic Surgery
2020
Introduction: Since the first revolution of robotic-assisted surgery officially happened in 2000, the healthcare service worldwide has transformed into a new era due to its superior technological advancements, particularly in laparoscopic surgery. Da Vinci which is seen as a master-slave system and Kymerax which is categorized as a hand-held device are commonly used in roboticassisted laparoscopic surgery. Whilst a conventional or open method requires a large incision to perform a surgery, laparoscopy a minimally invasive surgery (MIS) is an advantageous surgical method which reduces an abdominal incision to a minimum, and effectively exploited with robots. Methods: Based on available articles with the object of robotic surgical surgery, two SWOT analysis for Da Vinci and Kymerax were formulated to understand strengths, weaknesses, opportunities and threats of each system in comparison with the traditional laparoscopic surgery. From that, the future outlook is anticipated based on t...
Surgical Endoscopy, 2003
Background: The objective of this study was to compare the efficacy of the da Vinci robotic system using both the three-dimensional view (3D) and two-dimensional (2D) view options with traditional manually assisted laparoscopic techniques in performing standardized exercises. Methods: To evaluate surgical efficiency in the use of robotically assisted and manual laparoscopic surgery for standardized exercises six, last-year medical students without any surgical experience were selected. The exercises consisted of placing rings over receptacles, grasping a free hanging suture and cutting three pieces of it, running a suture, and performing a surgical knot. Each student performed the exercise twice. The median times needed for completion of the exercises and the median number of errors in performing the tasks were noted. Results: The unexperienced students performed the standardized tasks significantly quicker and with fewer errors when assisted by the da Vinci robot in the 3D optical display mode, as compared with traditional manually assisted laparoscopic surgery. Even when the 2D mode was selected, a significant advantage favoring the da Vinci robotic system was seen both in time and efficacy for most exercises. When the 3D and 2D modes were compared, time differences in favor of the 3D mode remained, but a significant difference in efficacy favoring the 3D mode was seen only in one exercise (exercise 2: suture cutting). Conclusions: The da Vinci robotic system permits standardized minimal invasive surgical exercises to be performed quicker and more efficiently than traditional minimally invasive techniques. Therefore, with the aid of this robotic system, difficult laparoscopic interventions may become easier to perform, and indications for minimal invasive surgery may be expanded.