Munshower Eva, Ren Emily, Bauerle Wayne B, Ruland Janice, Stoltzfus Jill, McDonald Marian, Baillie Daniel R, Chaar Maher El
Temple/St. Luke's School of Medicine, Bethlehem, PA, USA.
Department of Research and Innovation, St. Luke's University Health Network, Bethlehem, PA, USA.
J Robot Surg. 2023 Apr;17(2):557-564. doi: 10.1007/s11701-022-01434-5. Epub 2022 Aug 8.
Laparoscopy is currently the standard approach for minimally invasive general surgery procedures. However, robotic surgery is now increasingly being used in general surgery. Robotic surgery provides several advantages such as 3D-visualization, articulated instruments, improved ergonomics, and increased dexterity, but is also associated with an increased overall cost which limits its widespread use. In our institution, the robotic assisted approach is frequently used for the performance of general surgery cases including inguinal hernias, cholecystectomies and paraesophageal hernia (PEH) repairs. The primary aim of the study was to evaluate the differences in cost between a robotic and laparoscopic approach for the above-mentioned cases. With IRB approval, we conducted a retrospective cost analysis of patients undergoing inguinal hernia repairs, cholecystectomies and PEH repairs between June 2018 and November 2020. Patients who had a concomitant procedure, a revisional surgery, or bilateral inguinal hernia repair were excluded from the study. Cost analysis was performed using a micro-costing approach. Statistical significance was denoted by p < 0.05. There were no differences among the different groups in relation to age, gender, ethnicity, and BMI. The overall cost of the robotic (R-) approach compared to a laparoscopic (L-) approach was significantly lower for cholecystectomy ($3,199.96 vs $4019.89, p < 0.05). For inguinal hernia repairs and PEH repairs without mesh, we found no significant difference in overall costs between the R- and L- approach (R- $3835.06 vs L- $3783.50, p = 0.69) and (R- $6852.41 vs L- $6819.69, p = 0.97), respectively. However, the overall cost of PEH with mesh was significantly higher for the R- group compared to the L- group (R- $7,511.09 vs L- $6,443.32, p < 0.05). Based on our institutional cost data, use of a robotic approach when performing certain general surgery cases does not seem to be cost prohibitive.
腹腔镜检查目前是微创普通外科手术的标准方法。然而，机器人手术现在在普通外科中越来越多地被使用。机器人手术具有一些优势，如三维可视化、关节式器械、更好的人体工程学设计和更高的灵活性，但也伴随着总体成本的增加，这限制了其广泛应用。在我们机构，机器人辅助方法经常用于进行包括腹股沟疝、胆囊切除术和食管旁疝（PEH）修复在内的普通外科手术。该研究的主要目的是评估上述病例中机器人手术和腹腔镜手术方法在成本上的差异。经机构审查委员会批准，我们对2018年6月至2020年11月期间接受腹股沟疝修补术、胆囊切除术和PEH修复术的患者进行了回顾性成本分析。有同期手术、翻修手术或双侧腹股沟疝修补术的患者被排除在研究之外。成本分析采用微观成本核算方法。p < 0.05表示具有统计学意义。不同组在年龄、性别、种族和体重指数方面没有差异。与腹腔镜（L-）手术方法相比，机器人（R-）手术方法在胆囊切除术中的总体成本显著更低（3199.96美元对4019.89美元，p < 0.05）。对于腹股沟疝修补术和无补片的PEH修复术，我们发现R-和L-手术方法在总体成本上没有显著差异（R- 3835.06美元对L- 3783.50美元，p = 0.69）以及（R- 6852.41美元对L- 6819.69美元，p = 0.97）。然而，与L-组相比，R-组使用补片的PEH总体成本显著更高（R-7511.09美元对L- 6443.32美元，p < 0.05）。根据我们机构的成本数据，在进行某些普通外科手术时使用机器人手术方法似乎不会导致成本过高。
