Dobbs Ryan W, Magnan Brenden P, Abhyankar Nikita, Hemal Ashok K, Challacombe Ben, Hu Jim, Dasgupta Prokar, Porpiglia Francesco, Crivellaro Simone
Department of Urology, University of Illinois at Chicago, Chicago, IL, USA -
Department of Urology, University of Illinois at Chicago, Chicago, IL, USA.
Minerva Urol Nefrol. 2017 Aug;69(4):313-323. doi: 10.23736/S0393-2249.16.02866-6. Epub 2016 Dec 22.
The introduction of the robotic surgical platform has led to distinct changes in practice patterns and the utilization of minimally invasive surgery in urology. While use of the robotic system is associated with improvements in perioperative outcomes such as estimated blood loss and hospital stay, there are significant fixed and variable costs with the purchase, maintenance and use of the robotics system that has led many authors to investigate the cost effectiveness of robotic urologic surgery. We sought to examine the best current available evidence for the cost effectiveness of robotic urologic surgery.
Comprehensive electronic literature searches were conducted without language restriction to identify reports of published studies within PubMed/Medline, SCOPUS and Web of Science. Relevant articles were examined and reference lists cross referenced to find additional pertinent publications.
PubMed literature searches of "robot urology cost" (304 articles) "robotic prostatectomy cost" (215 articles), "robotic nephrectomy cost" (87 articles), "robotic cystectomy cost" (44 articles) and "robotic pyeloplasty cost" (41 articles) were initially reviewed in abstract form to find appropriate articles for inclusion. Given that robotic cystectomy (559 articles), robotic pyeloplasty (344 articles) robotic retroperitoneal lymph node dissection (59 articles) are less frequently performed than robotic prostatectomy, all available articles published from January 1st 2000 until July 31st 2016 were reviewed for potential inclusion. After excluding duplicates, appropriate articles were pulled for full text review. 49 articles were used for the final analysis.
The available literature on the cost effectiveness of robotic urologic surgery is somewhat limited by heterogeneity of research methods, local cost variations and methods for determining costs associated with surgical outcomes. The introduction of the robotic surgical platform has led to a dramatic change in the availability and utilization of laparoscopic surgery and is associated with both favorable perioperative outcomes as well as significantly greater fixed costs related to instrumentation and equipment expenses. Well-designed trials comparing open and robotic approaches in the contemporary era of widespread robotic adoption with quality of life and validated economic metrics will be necessary to provide evidence for continued use of this valuable technology.
机器人手术平台的引入已使泌尿外科的实践模式和微创手术的应用发生了显著变化。虽然使用机器人系统与围手术期结局的改善相关，如估计失血量和住院时间，但机器人系统的购买、维护和使用存在大量固定和可变成本，这促使许多作者研究机器人泌尿外科手术的成本效益。我们试图审查关于机器人泌尿外科手术成本效益的当前最佳现有证据。
进行了全面的电子文献检索，无语言限制，以确定在PubMed/Medline、SCOPUS和科学网中发表的研究报告。对相关文章进行了审查，并交叉引用参考文献列表以找到其他相关出版物。
最初以摘要形式审查了PubMed文献中搜索的“机器人泌尿外科成本”（304篇文章）、“机器人前列腺切除术成本”（215篇文章）、“机器人肾切除术成本”（87篇文章）、“机器人膀胱切除术成本”（44篇文章）和“机器人肾盂成形术成本”（41篇文章），以找到合适的文章纳入。鉴于机器人膀胱切除术（559篇文章）、机器人肾盂成形术（344篇文章）、机器人腹膜后淋巴结清扫术（59篇文章）的实施频率低于机器人前列腺切除术，对2000年1月1日至2016年7月31日期间发表的所有可用文章进行了审查，以确定是否可能纳入。在排除重复项后，提取合适的文章进行全文审查。49篇文章用于最终分析。
关于机器人泌尿外科手术成本效益的现有文献在一定程度上受到研究方法的异质性、当地成本差异以及确定与手术结局相关成本的方法的限制。机器人手术平台的引入导致了腹腔镜手术的可及性和应用发生了巨大变化，并且与良好的围手术期结局以及与仪器设备费用相关的显著更高的固定成本相关。在机器人广泛应用的当代，设计良好的比较开放和机器人手术方法并结合生活质量和经过验证的经济指标的试验，对于为继续使用这一有价值的技术提供证据是必要的。
