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A Comparative Cost Analysis of Pediatric Urological Robotic-Assisted Laparoscopic Surgery vs. Open surgery
Lisa V. Ferreira, BSPS, Brian J. Minnillo, M.D., Fernando A. Carvas, M.D. Katherine Tecci, MBA, Courtney K. Rowe, M.D., Alan B. Retik, M.D., Hiep T. Nguyen, M.D.
Children's Hospital Boston, Boston, MA, USA.

Purpose: The use of robotic surgical tools, such as the da Vinci Surgical System (Sunnyvale, CA, USA), may alter the way pediatric surgeons approach complex laparoscopic reconstructive procedures. Despite some early success in pediatric robotic surgery, the field continues to evolve and technical and surgical challenges remain. While clinical outcomes and long-term experience continue to be evaluated, the potential financial implications have not been clearly defined, especially in children. The purpose of this study is to perform a case-specific cost analysis comparing multiple pediatric urology robotic procedures with their open counterparts.
Methods: A series of 75 robotic-assisted laparoscopic cases matched with a similar open procedure in the same fiscal year were identified from October 2004 to September 2009. These cases were similar with respect to age, sex and surgical procedure performed. A cost assessment was performed by sensitivity analysis using a generated cost model, which includes operative time, anesthesia fees, consumables, hospital room/board, pharmacy, and capital equipment depreciation.
Results: Robotic-assisted laparoscopic surgery was 20% more costly than open surgery when considering increased consumables and the depreciation of the expensive da Vinci system. However, if factoring for depreciation and analyzing the costs based on hospital length of stay and dispersing the operative costs over a higher number of cases, the robotic costs are comparable to open surgery.
Conclusion: In general, the increased costs driven by amortization, robotic maintenance, costs of consumable equipment, and potentially longer operative times will result in higher robotic costs over conventional open or laparoscopic surgery. Robotic procedures were considered cost-effective for our institution only if the hospital performs at a high-volume with better perioperative and postopertive outcomes such as shorter operative time and hospital stay.


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