Robotic cholecystectomy: much higher costs, same outcomes

Last Updated: 2016-01-04

By Anne Harding

NEW YORK (Reuters Health) - Robotic and single-incision minimally invasive gallbladder surgery offer substantially less surgical value than traditional laparoscopic cholecystectomy, according to new study.

"Robotic surgery may have some uses in general surgery down the road, but gallbladder surgery is not going to be one of them," coauthor Dr. Richard Newman, of St. Francis Hospital and Medical Center in Hartford, Connecticut, told Reuters Health in a telephone interview. "In response to this paper we are no longer doing robotic gallbladder surgery at this hospital."

Introduced in the 1980s, four-port laparoscopic cholecystectomy became the standard of care for noncomplicated gallbladder disease in 1992, Dr. Newman and his colleagues wrote in their report, published online December 21 in the Journal of the American College of Surgeons. The benefits of traditional laparoscopic cholecystectomy (TLC) over open surgery were clear, they added, with less pain after surgery, smaller scars, shorter hospital stay, and faster return to normal activity.

The benefits are less clear for single-incision laparoscopic cholecystectomy (SILS) and robotically assisted laparoscopic cholecystectomy (ROBOSILS), Dr. Newman and his team added. Some studies have found shorter hospital stay or faster recovery with SILS compared to TLC, they noted, while others suggest a higher cost and higher rate of complications for the newer procedures.

In the new study, the researchers compared the surgical value (outcome divided by cost) for 50 consecutive TLCs and 50 consecutive non-traditional TLCs (NTLCs), including 11 SILS and 39 ROBOSILS.

The primary outcomes, minimally invasive gallbladder removal and same-day discharge, were similar with TLCs and NTLCs. Emergency department visits and readmissions, the study's secondary outcomes, were also similar in the two groups.

But direct variable surgeon cost (DVSC), which included surgical supplies, instruments, technology, and procedure time, was $929 for TLC and $2,344 with NTLC (p<0.5). The DVSC for SILS was $1,407, and it was $2,608 for ROBOSILS. The relative surgical value was 0.34 for NTLC compared to 1.0 for TLC; it was 0.66 for SILS and 0.36 for ROBOSILS.

Understanding surgical value is crucial, especially for a very high-volume procedure such as gallbladder surgery, Dr. Newman said. "About a million of these cases are done every year."

Robotic surgery has taken hold in gynecology and urology, the researcher added, in part thanks to direct marketing to patients by manufacturers of robotic instruments. While general surgeons have not been as quick to adopt the robotic approach, he added, some decide to do so because of patient demand. "Occasionally it's patients asking for robotic surgery, and occasionally it's doctors wanting to get a new niche of the market because they think the new technology is going to drive patients toward them."

The authors reported no external funding or disclosures.

SOURCE: http://bit.ly/1OHB5NY

J Am Coll Surg 2015.