You have accessJournal of UrologyTechnology & Instruments: Laparoscopy and Robotics: Malignant Disease II1 Apr 2015PD18-05 ROBOTIC NEPHRECTOMY IS NOT COSTLIER THAN STANDARD LAPAROSCOPY WHEN A ROBOT IS AVAILABLE Ronney Abaza, Iahn Gonsenhauser, Geoffrey Box, David Sharp, and Ahmad Shabsigh Ronney AbazaRonney Abaza More articles by this author , Iahn GonsenhauserIahn Gonsenhauser More articles by this author , Geoffrey BoxGeoffrey Box More articles by this author , David SharpDavid Sharp More articles by this author , and Ahmad ShabsighAhmad Shabsigh More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2015.02.690AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES While robotic surgical systems are unlikely to be purchased by institutions specifically to perform nephrectomy, it is uncertain whether surgeons at hospitals already owning robotic equipment should perform standard laparoscopic nephrectomy (LN) versus robotic nephrectomy (RN) when the robot is available. We compared our institutional costs for LN versus RN and developed a cost model to address this issue. METHODS The average total costs (indirect and direct) associated with LN and RN were assessed at a single institution, including all nephrectomies performed from February 2008 to February 2010. During this time period, RN was performed uniformly by one surgeon and only LN performed by 3 other surgeons, such that no selection bias existed in choice of surgical approach. After this time, surgeons performing LN began performing RN as well. Cost minimalization analysis was used for comparison. All figures used were true costs as continuously measured by the institution rather than charges or collections. The cost categories evaluated included hospital stay, pharmacy/medical therapy, labs and other diagnostics, operating room, recovery, anesthesia and outpatient ancillary costs. RESULTS A total of 150 nephrectomies were performed during the study period, including 90 LN and 60 RN. The average total costs of LN (mean=$12,021) and RN (mean=$11,861) did not differ (p=0.79) when assuming a robot was available, or when fixed costs of the robot were not included. The additional cost of performing RN over LN as represented by actual fixed costs of owning and maintaining robots, including depreciation of the robot but not laparoscopic equipment, was an average additional $1,040 per procedure. The average cost of standard instrumentation and disposables used for LN and RN were $2,344 and $2,010, respectively. The cost of robotic instruments was outweighed by the number of disposable trocars used for LN and the cost of stapling devices, clip appliers, and advanced energy dissection devices. CONCLUSIONS Surgeons at institutions already owning robotic surgical systems can perform RN without necessarily incurring higher costs than LN. When the fixed costs of owning a robot (depreciation and maintenances) are included, these additional costs per case surpass savings in disposables as compared with LN. Cost Category Laparoscopic Direct Laparoscopic Indirect Robotic Direct Robotic Indirect Total Laparoscopy Total Robotic Hospital Stay $1,122 $1,199 $665 $881 $2,321 $1,633 Pharmacy/Medical Therapy $1,848 $475 $2,501 $532 $2,323 $3,034 Labs and Diagnostics $174 $289 $92 $167 $463 $259 OR/Recovery/Anesthesia $2,499 $4,392 $2,387 $4,506 $6,891 $6,893 Outpatient Ancillary $13 $10 $17 $25 $23 $42 Total Costs $5,656 $6,365 $5,716 $6,145 $12,021 $11,861 © 2015 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 193Issue 4SApril 2015Page: e388 Advertisement Copyright & Permissions© 2015 by American Urological Association Education and Research, Inc.MetricsAuthor Information Ronney Abaza More articles by this author Iahn Gonsenhauser More articles by this author Geoffrey Box More articles by this author David Sharp More articles by this author Ahmad Shabsigh More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...