Robotic Surgery, Research and Training Center, Department of Urology, Children's Hospital, Boston, Massachusetts 02115, USA.
J Endourol. 2012 Jul;26(7):871-7. doi: 10.1089/end.2011.0584. Epub 2012 Mar 14.
Cost in healthcare is an increasing and justifiable concern that impacts decisions about the introduction of new devices such as the da Vinci(®) surgical robot. Because equipment expenses represent only a portion of overall medical costs, we set out to make more specific cost comparisons between open and robot-assisted laparoscopic surgery.
We performed a retrospective, observational, matched cohort study of 146 pediatric patients undergoing either open or robot-assisted laparoscopic urologic surgery from October 2004 to September 2009 at a single institution. Patients were matched based on surgery type, age, and fiscal year. Direct internal costs from the institution were used to compare the two surgery types across several procedures.
Robot-assisted surgery direct costs were 11.9% (P=0.03) lower than open surgery. This cost difference was primarily because of the difference in hospital length of stay between patients undergoing open vs robot-assisted surgery (3.8 vs 1.6 days, P<0.001). Maintenance fees and equipment expenses were the primary contributors to robotic surgery costs, while open surgery costs were affected most by room and board expenses. When estimates of the indirect costs of robot purchase and maintenance were included, open surgery had a lower total cost. There were no differences in follow-up times or complication rates.
Direct costs for robot-assisted surgery were significantly lower than equivalent open surgery. Factors reducing robot-assisted surgery costs included: A consistent and trained robotic surgery team, an extensive history of performing urologic robotic surgery, selection of patients for robotic surgery who otherwise would have had longer hospital stays after open surgery, and selection of procedures without a laparoscopic alternative. The high indirect costs of robot purchase and maintenance remain major factors, but could be overcome by high surgical volume and reduced prices as competitors enter the market.
医疗成本是一个日益受到关注且合理的问题，它会影响到新设备（如达芬奇手术机器人）引入的决策。由于设备费用仅占总医疗费用的一部分，因此我们着手对开放式手术和机器人辅助腹腔镜手术之间的更具体的成本进行比较。
我们在一家机构对 2004 年 10 月至 2009 年 9 月期间接受开放式或机器人辅助腹腔镜泌尿外科手术的 146 名儿科患者进行了回顾性、观察性、匹配队列研究。根据手术类型、年龄和财政年度对患者进行匹配。使用机构的直接内部成本来比较两种手术类型的几种手术。
机器人辅助手术的直接成本比开放式手术低 11.9%（P=0.03）。这种成本差异主要是由于接受开放式与机器人辅助手术的患者之间的住院时间差异（3.8 天与 1.6 天，P<0.001）。维护费用和设备费用是机器人手术成本的主要贡献者，而开放式手术成本则受房间和床位费用的影响最大。当包括机器人购买和维护的间接成本估算时，开放式手术的总成本较低。两种手术类型在随访时间或并发症发生率方面无差异。
机器人辅助手术的直接成本明显低于等效的开放式手术。降低机器人辅助手术成本的因素包括：有一个经验丰富的机器人手术团队、广泛的泌尿外科机器人手术历史、选择机器人手术的患者，如果进行开放式手术，他们的住院时间会更长，以及选择没有腹腔镜替代方案的手术。机器人购买和维护的高间接成本仍然是主要因素，但随着竞争对手进入市场，高手术量和降低价格可能会克服这些因素。
