James Buchanan Brady Urological Institute, Johns Hopkins Medical Institutions, Baltimore, Maryland 21230, USA.
J Endourol. 2012 Jul;26(7):843-7. doi: 10.1089/end.2011.0522. Epub 2012 Feb 24.
Robot-assisted laparoscopic partial nephrectomy (RALPN) is supplanting traditional laparoscopic partial nephrectomy (LPN) as the technique of choice for minimally invasive nephron-sparing surgery. This evolution has resulted from potential clinical benefits, as well as proliferation of robotic systems and patient demand for robot-assisted surgery. We sought to quantify the costs associated with the use of robotics for minimally invasive partial nephrectomy.
A cost analysis was performed for 20 consecutive robot-assisted partial nephrectomy (RPN) and LPN patients at our institution from 2009 to 2010. Data included actual perioperative and hospitalization costs as well as professional fees. Capital costs were estimated using purchase costs and amortization of two robotic systems from 2001 to 2009, as well as maintenance contract costs. The estimated cost/case was obtained using total robotic surgical volume during this period. Total estimated costs were compared between groups. A separate analysis was performed assuming "ideal" robotic utilization during a comparable period.
RALPN had a cost premium of +$1066/case compared with LPN, assuming actual robot utilization from 2001 to 2009. Assuming "ideal" utilization during a comparable period, this premium decreased to +$334; capital costs per case decreased from $1907 to $1175. Tumor size, operative time, and length of stay were comparable between groups.
RALPN is associated with a small to moderate cost premium depending on assumptions regarding robotic surgical volume. Saturated utilization of robotic systems decreases attributable capital costs and makes comparison with laparoscopy more favorable. Purported clinical benefits of RPN (eg, decreased warm ischemia time, increased utilization of nephron-sparing surgery) need further study, because these may have cost implications.
机器人辅助腹腔镜肾部分切除术（RALPN）正在取代传统腹腔镜肾部分切除术（LPN），成为微创保肾手术的首选技术。这种演变源自潜在的临床益处，以及机器人系统的普及和患者对机器人辅助手术的需求。我们旨在量化与微创肾部分切除术使用机器人相关的成本。
对 2009 年至 2010 年在我院接受连续 20 例机器人辅助肾部分切除术（RPN）和腹腔镜肾部分切除术（LPN）的患者进行了成本分析。数据包括实际围手术期和住院费用以及专业费用。使用从 2001 年至 2009 年购买成本和机器人系统摊销以及维护合同成本来估算资本成本。使用该期间的总机器人手术量获得了每例手术的估计成本。比较了两组之间的总估计成本。在类似时期假设“理想”机器人利用率进行了单独分析。
假设从 2001 年至 2009 年实际使用机器人，则与 LPN 相比，RALPN 的成本溢价为每例+1066 美元。在类似时期假设“理想”利用率的情况下，溢价降低至+334 美元；每例的资本成本从 1907 美元降至 1175 美元。肿瘤大小、手术时间和住院时间在两组之间无差异。
根据机器人手术量的假设，RALPN 与适度的成本溢价相关。机器人系统的饱和利用降低了可归因的资本成本，并使与腹腔镜的比较更加有利。RALPN 的潜在临床益处（例如，减少热缺血时间，增加保肾手术的利用率）需要进一步研究，因为这可能会带来成本影响。
