Cost comparison of single site robotic and conventional laparoscopic cholecystectomy at a single institution
Lee MM, Seeras KK, and Lim JJ. Cost comparison of single site robotic and conventional laparoscopic cholecystectomy at a single institution. Surg Endosc 2019; 33:S395.
Introduction: Single site robotic (SSR) cholecystectomy has become a popular technique at our institution with similar if not improved patient satisfaction compared to conventional laparoscopic (CL) cholecystectomy. Prior studies have suggested that these favorable patient outcomes are attenuated by the high cost of the robot. This study was designed to compare direct hospital costs between these two techniques on a case by case basis, excluding the capital purchase cost of the robot. Methods: This is a retrospective, single site, single surgeon study comparing the cost of outpatient cholecystectomies using either single site robotic (SSR) or conventional four-port laparoscopic (CL) techniques. Patient demographic data, case duration, and hospital financial data were obtained from electronic medical records. We excluded those cholecystectomies requiring intraoperative cholangiograms, umbilical hernia repairs or other concomitant procedures such as liver biopsy. We analyzed the total cost of disposable equipment on a caseby- case basis and excluded amortization costs of the robot. Charges unique to the SSR group included robot-specific drapes, single site port, seals, hooks, hem-o-lock clips, and crocodile graspers while charges for the CL group included disposable trocars and endoclips. Continuous variables were described using the mean and SD or median (IQR) and categorical variables were described with the frequency and percentage. Student t test or Wilcoxon rank test was used for continuous variables, Chi square test or Fisher's exact test was used to categorical variables, as appropriate. Results: A total of 125 patients were included in the analysis. These patients had either undergone conventional laparoscopy (n = 44) or single site robotic cholecystectomy (n = 81) for an indicated diagnosis of biliary dyskinesia (n = 40) or symptomatic cholelithiasis (n = 85). There was no significant difference between groups in age, sex or ASA classification however, BMI was significantly higher in the CL group (33.5 ± 7.7 vs 28.9 ± 5.7, p = 0.002). Anesthesia time >119 (110-160) vs 134 (122-170) minutes, p = 0.008] and skin-to skin operative time (70.1 ± 24.7 vs 82.7 ± 22.7 min, p = 0.005) were higher in the SSR group. After exclusion of the capital cost of the robot and operating room costs, there was no significant difference between median hospital cost for CL and SSR groups ($488.9 (428.5-562.3) vs $472.3 (293.5- 563), p = 0.22) per case. Conclusions: Our data suggests that in the setting of outpatient cholecystectomy there is no difference in cost between SSR and CL cholecystectomy when anesthesia time and capital cost of the robot are excluded.