Monika E Hagen, Alexandre Balaphas, Minoa K Jung, Nicolas C Buchs, Leo Buehler, Philippe Morel. University Hospital Geneva
Background: Multiport laparoscopy is the gold standard approach for cholecystectomy. Single port laparoscopy has been developed in an attempt to further reduce the invasiveness and research hints towards better cosmetic outcomes and potentially reduced postoperative pain. A specific robotic single port platform (da Vinci Single Site, Intuitive Surgical Inc.) has been released in 2011, which facilitates single site cholecystectomy technically. Current data shows its feasibility, but detailed short- and long-term analyses of costs with comparison to the gold standard approach have not been published to date.
Methods: Patients who underwent robotic single site cholecystectomy for benign, non-inflammatory disease between 2011 and 2013 were matched for disease, age, gender, BMI, ASA classification, diagnosis and year of surgery to a cohort of multiport cholecystectomies. Demographic, peri-operative and long-term data was collected and analyzed. Peri-operative cost was modeled by including the capital investment and yearly maintenance of the robotic system, instrument usage during surgery, operating room time and length of stay based on clinical and hospital administrative data. Long-term costs included re-operations due to the primary procedure until August 2016. Cost data for re-operations was derived from hospital administrative database.
Results: 78 patients who underwent robotic single site cholecystectomy were successfully matched to 78 patients with multiport cholecystectomy. With comparable demographic parameters, operating room time (robotic 93.9 versus laparoscopic 82.5 minutes, p=0.1019), length of stay (robotic 2.4 versus laparoscopic 2.3, p=0.6877) and 30-day reoperation rate (0 versus 0, p=1) was similar for both cohorts. Cost for surgery was USD 4176.6 for the robotic and USD 2026.9 for the laparoscopic cohort (p=0.0001). Cost of hospitalization was comparable with USD 4320.5 for the robotic and USD 3249.5 for the laparoscopic procedure (p=0.6282). Mean follow-up time of both cohorts was 4.5 years (p=1). Six patients of the robotic cohort and none of the laparoscopic patients underwent a repair of an incisional hernia as a result of the cholecystectomy (p=0.0066). Mean long-term cost associated with the initial cholecystectomy was USD 1460.8 for the robotic and USD 0 for the multiport laparoscopic group (p=0.0066).
Conclusions: With similar peri-operative clinical results, surgical and long-term costs are significantly higher with robotic single site cholecystectomy when compared to multiport cholecystectomy. Considering the unclear clinical value of robotic single site cholecystectomy and the increased short- and long-term costs, a debate as to who should cover the surgical costs beyond the ones of the gold standard treatment appears reasonable.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 80206
Program Number: S142
Presentation Session: Plenary 2
Presentation Type: Podium