Robotic single-site versus laparoscopic cholecystectomy: Which is cheaper? A cost report and analysis.

Abstract

There is a need for a comparison of costs of robotic single-site cholecystectomy (RSSC) and laparoscopic cholecystectomy (LC) in the US healthcare model. Cholecystectomy is one of the most common procedures in general surgery. Single-incision laparoscopic surgery is beneficial but cumbersome. Robotic surgery is ergonomic but expensive. Costs of RSSC and LC have not been compared within the US healthcare model. Cost categories were compared between RSSC and LC in consecutive outpatient-elective cases during the same period. Cost efficiency of outpatient-elective cases before and after the first 50 institutional RSSC cases (including outpatients, inpatients, emergent, and elective) were compared to investigate for a learning curve that would subsequently affect cost. A total of 458 cases included 177 RSSCs and 281 LCs. Non-emergent non-admitted cases included in cost analysis were 46 RSSCs and 175 LCs. Costs were less with RSSC: median total ($1319 vs. $1710, p < 0.001), driven mainly by cost category "Supplies" ($913 vs. $1244, p < 0.001), and to a lesser extent "Operating room" ($196 vs. $232, p < 0.001), and "Anesthesiology" ($127 vs. $168, p < 0.001). Supplies were responsible for 87% of median total cost reduction. Other cost categories were not significantly different. There were 11 and 9% drops (p < 0.006) in RSSC OR times and costs, respectively, after our 50th institutional case. In a hospital that has already acquired infrastructure for robotic surgery, we observed procedural costs for RSSC that were lower than LC. This decreased cost was mainly driven by cutting down on supplies (87% of median total cost reduced), and to a lesser extent OR time. A steep learning curve exists after which RSSC OR times can be significantly shortened. A randomized study is needed.