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Surgical Endoscopy
Published in: Surgical Endoscopy 9/2020

01-09-2020 | Colectomy

Is robotic right colectomy economically sustainable? a multicentre retrospective comparative study and cost analysis

Authors: Giovanni Merola, Antonio Sciuto, Felice Pirozzi, Jacopo Andreuccetti, Giusto Pignata, Francesco Corcione, Marco Milone, Giovanni Domenico De Palma, Rossana Castaldo, Leandro Pecchia, Graziano Ceccarelli, Umberto Bracale

Published in: Surgical Endoscopy | Issue 9/2020

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Abstract

Background

Following the Food and Drug Administration approval, robot-assisted colorectal surgery has gained more acceptance among surgeons. One of the open issues about robotic surgery is the economic sustainability. The aim of our study is to evaluate the economic sustainability of robotic as compared to laparoscopic right colectomy for the Italian National Health System.

Methods

We performed a retrospective multicentre case-matched study including 94 patients for each group from four different Italian surgical departments. An economic evaluation gathered from a real-world data was performed to assess the sustainability of the robotic approach for right colectomy in the Italian National Health System. In particular, a differential cost analysis between the two procedures was performed.

Results

No statistical differences were found between the two groups for postoperative outcomes. After a careful review of the literature on the cost assessment for the operative room, medical devices and hospital stay according with our data, we estimated the followings: (a) the mean operative room cost for robotic group was 2179 ± 476 € vs. 1376 ± 322 € for laparoscopic group; (b) the mean hospital stay cost for robotic group was 3143 ± 1435 € vs. 3292 ± 1123 € for laparoscopic group; and (c) the mean cost for instruments was 6280 € for robotic group vs. 1504 € for laparoscopic group. The total mean cost of robotic right colectomy was 11,576 ± 1915 € vs. 6196 ± 1444 € for laparoscopic right colectomy.

Conclusion

In conclusion, to date, robotic right colectomy with intracorporeal anastomosis does not provide any significant clinical advantages, which may justify the additional costs, as compared to its laparoscopic counterpart. Further evolution of robotic technology and experience may lead to a reduction of costs, especially if the robotic platform is used in an appropriate healthcare setting.
Literature
1.
Bracale U et al (2013) Single access laparoscopic left hemicolectomy with or without inferior mesenteric artery preservation: our preliminary experience. Minerva Chir 68(3):315–320PubMed
2.
3.
Milone M et al (2015) Intracorporeal versus extracorporeal anastomosis. Results from a multicentre comparative study on 512 right-sided colorectal cancers. Surg Endosc 29(8):2314–2320PubMedCrossRef
4.
Casciola L et al (2003) Laparoscopic right hemicolectomy with intracorporeal anastomosi. Technical aspects and personal experience. Minerva Chir 58(4):621–627PubMed
5.
Damle A et al (2017) Diffusion of technology: trends in robotic-assisted colorectal surgery. Am J Surg 214(5):820–824PubMedCrossRef
6.
Fung AK, Aly EH (2013) Robotic colonic surgery: is it advisable to commence a new learning curve? Dis Colon Rectum 56(6):786–796PubMedCrossRef
7.
Ballantyne GH, Moll F (2003) The da Vinci telerobotic surgical system: the virtual operative field and telepresence surgery. Surg Clin N Am 83(6):1293–1304PubMedCrossRef
8.
9.
Wittekind C, Oberschmid B (2010) TNM classification of malignant tumors 2010: General aspects and amendments in the general section. Pathologe 31(5):333–338PubMedCrossRef
10.
Clavien PA et al (2009) The clavien-dindo classification of surgical complications: five-year experience. Ann Surg 250(2):187–196PubMedCrossRef
11.
12.
Bracale U et al (2018) The use of barbed suture for intracorporeal mechanical anastomosis during a totally laparoscopic right colectomy: is it safe? a retrospective nonrandomized comparative multicenter study. Surg Innov 25(3):267–273PubMedCrossRef
13.
Shaw DD et al (2018) Robotic colorectal surgery learning curve and case complexity. J Laparoendosc Adv Surg Tech A 28(10):1163–1168PubMedCrossRef
14.
Bracale U et al (2015) Single-access laparoscopic rectal resection versus the multiport technique: a retrospective study with cost analysis. Surg Innov 22(1):46–53PubMedCrossRef
15.
Bracale U et al (2014) Beneficial effects of fibrin glue (Quixil) versus Lichtenstein conventional technique in inguinal hernia repair: a randomized clinical trial. Hernia 18(2):185–192PubMedCrossRef
16.
Rayburn L, Rayburn J (1984) Using the differential costing concept for healthcare decisions. Healthc comput commun 1(11):26PubMed
17.
Edelman DS, Hodde JP (2011) Update on bioactive prosthetic material for the treatment of hernias. Surg Technol Int 21:135–139PubMed
18.
Cuccurullo D et al (2015) Relaparoscopy for management of postoperative complications following colorectal surgery: ten years experience in a single center. Surg Endosc 29(7):1795–1803PubMedCrossRef
19.
Milone M et al (2015) Colorectal resection in deep pelvic endometriosis: surgical technique and post-operative complications. World J Gastroenterol 21(47):13345–13351PubMedPubMedCentralCrossRef
20.
Reggio S et al (2015) Single-layer versus double-layer closure of the enterotomy in laparoscopic right hemicolectomy with intracorporeal anastomosis: a single-center study. Tech Coloproctol 19(12):745–750PubMedCrossRef
21.
Roscio F et al (2012) Totally laparoscopic versus laparoscopic assisted right colectomy for cancer. Int J Surg 10(6):290–295PubMedCrossRef
22.
Spinoglio G et al (2018) Robotic versus laparoscopic right colectomy with complete mesocolic excision for the treatment of colon cancer: perioperative outcomes and 5-year survival in a consecutive series of 202 patients. Ann Surg Oncol 25(12):3580–3586PubMedCrossRef
23.
Solaini L et al (2018) Robotic versus laparoscopic right colectomy with intracorporeal anastomosis: a multicenter comparative analysis on short-term outcomes. Surg Endosc 33(6):1898–1902PubMedCrossRef
24.
de’Angelis N et al (2016) Laparoscopic extended right colectomy versus laparoscopic left colectomy for carcinoma of the splenic flexure: a matched case-control study. Int J Colorectal Dis 31(3):623–630PubMedCrossRef
25.
Armijo PR et al (2018) Growth in robotic-assisted procedures is from conversion of laparoscopic procedures and not from open surgeons’ conversion: a study of trends and costs. Surg Endosc 32(4):2106–2113PubMedCrossRef
26.
Solaini L et al (2018) Robotic versus laparoscopic right colectomy: an updated systematic review and meta-analysis. Surg Endosc 32(3):1104–1110PubMedCrossRef
27.
Petrucciani N et al (2015) Robotic right colectomy: a worthwhile procedure? results of a meta-analysis of trials comparing robotic versus laparoscopic right colectomy. J Minim Access Surg 11(1):22–28PubMedPubMedCentralCrossRef
28.
Park JS et al (2012) Randomized clinical trial of robot-assisted versus standard laparoscopic right colectomy. Br J Surg 99(9):1219–1226PubMedCrossRef
29.
Khorgami Z et al (2018) The cost of robotics: an analysis of the added costs of robotic-assisted versus laparoscopic surgery using the National Inpatient Sample. Surg Endosc 33(7):2217–2221PubMedCrossRef
30.
Tillou J et al (2018) The impact of surgeon choices on costs associated with uncomplicated minimally invasive colectomy: you are not as important as you think. Gastroenterol Rep (Oxf) 6(2):108–113CrossRef
31.
Higgins RM et al (2017) Cost analysis of robotic versus laparoscopic general surgery procedures. Surg Endosc 31(1):185–192PubMedCrossRef
32.
Berto P et al (2012) Cost of laparoscopy and laparotomy in the surgical treatment of colorectal cancer. Surg Endosc 26(5):1444–1453PubMedCrossRef
33.
Lemanu DP et al (2014) A systematic review to assess cost effectiveness of enhanced recovery after surgery programmes in colorectal surgery. Colorectal Dis 16(5):338–346PubMedCrossRef
34.
Toh JWT et al (2018) Association of mechanical bowel preparation and oral antibiotics before elective colorectal surgery with surgical site infection: a network meta-analysis. JAMA Netw Open 1(6):e183226PubMedPubMedCentralCrossRef
35.
Angelis N et al (2016) Robotic versus laparoscopic right colectomy for colon cancer: analysis of the initial simultaneous learning curve of a surgical fellow. J Laparoendosc Adv Surg Tech A 26(11):882–892CrossRef
Metadata
Title
Is robotic right colectomy economically sustainable? a multicentre retrospective comparative study and cost analysis
Authors
Giovanni Merola
Antonio Sciuto
Felice Pirozzi
Jacopo Andreuccetti
Giusto Pignata
Francesco Corcione
Marco Milone
Giovanni Domenico De Palma
Rossana Castaldo
Leandro Pecchia
Graziano Ceccarelli
Umberto Bracale
Publication date
01-09-2020
Publisher
Springer US
Published in
Surgical Endoscopy / Issue 9/2020
Print ISSN: 0930-2794
Electronic ISSN: 1432-2218
DOI
https://doi.org/10.1007/s00464-019-07193-z

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