Paediatric robotic surgery in clinical practice: a cost analysis.

Area of Science:

• Pediatric Surgery
• Minimally Invasive Surgery
• Surgical Technology

Background:

• Robotic assistance has been utilized for minimally invasive laparoscopic fundoplications in children since 2006.
• A cost comparison was performed between robotic, laparoscopic, and open surgical approaches to evaluate the financial viability of new surgical technologies.

Purpose of the Study:

• To compare the costs of robotic-assisted surgery with traditional open and laparoscopic surgery for pediatric fundoplications.
• To determine if the increased costs associated with robotic surgery are justified by patient outcomes and potential cost offsets.

Main Methods:

• Cost analysis of the first 14 pediatric fundoplications using the da Vinci Surgical System.
• Comparison of these costs with the ten most recent open and laparoscopic fundoplications.
• Ensured no significant differences in patient demographics, pre-operative work-up, or surgical indications across the three groups.

Main Results:

• Robotic fundoplications (EUR 9,584) were 7% more expensive than laparoscopic (EUR 8,982) but 9% cheaper than open surgery (EUR 10,521).
• Increased instrument costs (EUR 2,081/operation) were the primary driver of higher robotic surgery expenses.
• Patients undergoing robotic surgery experienced comparable operative times to laparoscopy, shorter hospital stays than open surgery, reduced morphine use, and shorter hospitalizations.

Conclusions:

• Introduction of robotic assistance increases initial hospital costs, primarily due to instrument expenses.
• Shorter hospital stays compared to open surgery can offset increased costs; hospital stays are similar to laparoscopic procedures.
• Future cost-efficiency is anticipated with cheaper instruments and reduced operating times, with patient benefits including less trauma and shorter hospital stays making the investment worthwhile.