Surgical cost of robotic-assisted sacrocolpopexy: a comparison of two robotic platforms.

Abstract

Robotic assistance in pelvic organ prolapse surgery can improve surgeon ergonomics and instrument dexterity compared with traditional laparoscopy but at increased costs. To compare total costs for robotic-assisted sacrocolpopexy (RSC) between two robotic platforms at an academic medical center. Retrospective cohort of Senhance (Ascensus) RSC between 1/1/2019 and 6/30/21 who were matched 2:1 with DaVinci (Intuitive) RSC. Primary outcome was total costs to hospital system; secondarily we evaluated cost sub-categories. Purchase costs of the robotic systems were not included. T-test, chi-square, and Fisher's exact tests were used. A multivariable linear regression was performed to model total costs adjusting for potential confounders. The matched cohort included 75 subjects. The 25 Senhance and 50 DaVinci cases were similar overall, with mean age 60.5±9.7, BMI 27.9±4.7, and parity 2.5±1.0. Majority were white (97.3%) and postmenopausal (86.5%) with predominantly stage III prolapse (64.9%). Senhance cases had longer OR times (Δ=32.1 min, p=0.01). There were no differences in concomitant procedures, intraoperative complications, or short-term postoperative complications between platforms (all p>0.05). On univariable analysis, costs were similar (Senhance $5368.31±1486.89, DaVinci $5741.76±1197.20, p=0.29). Cost subcategories (medications, supplies, etc.) were also similar (all p>0.05). On multivariable linear regression, total cost was $908.33 lower for Senhance (p=0.01) when adjusting for operative time, estimated blood loss, concomitant mid-urethral sling, and use of the GelPoint mini port system. Despite longer operating times, total cost of robotic-assisted sacrocolpopexy was significantly lower when using the Senhance compared to the DaVinci system.