Skip to main page content
Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Comparative Study
, 31 (9), 1639-48

Robot-assisted Versus Laparoscopic Rectal Resection for Cancer in a Single Surgeon's Experience: A Cost Analysis Covering the Initial 50 Robotic Cases With the Da Vinci Si

Affiliations
Comparative Study

Robot-assisted Versus Laparoscopic Rectal Resection for Cancer in a Single Surgeon's Experience: A Cost Analysis Covering the Initial 50 Robotic Cases With the Da Vinci Si

Luca Morelli et al. Int J Colorectal Dis.

Abstract

Purpose: The aim of this study is to compare surgical parameters and the costs of robotic surgery with those of laparoscopic approach in rectal cancer based on a single surgeon's early robotic experience.

Methods: Data from 25 laparoscopic (LapTME) and the first 50 robotic (RobTME) rectal resections performed at our institution by an experienced laparoscopic surgeon (>100 procedures) between 2009 and 2014 were retrospectively analyzed and compared. Patient demographic, procedure, and outcome data were gathered. Costs of the two procedures were collected, differentiated into fixed and variable costs, and analyzed against the robotic learning curve according to the cumulative sum (CUSUM) method.

Results: Based on CUSUM analysis, RobTME group was divided into three phases (Rob1: 1-19; Rob2: 20-40; Rob3: 41-50). Overall median operative time (OT) was significantly lower in LapTME than in RobTME (270 vs 312.5 min, p = 0.006). A statistically significant change in OT by phase of robotic experience was detected in the RobTME group (p = 0.010). Overall mean costs associated with LapTME procedures were significantly lower than with RobTME (p < 0.001). Statistically significant reductions in variable and overall costs were found between robotic phases (p < 0.009 for both). With fixed costs excluded, the difference between laparoscopic and Rob3 was no longer statistically significant.

Conclusions: Our results suggest a significant optimization of robotic rectal surgery's costs with experience. Efforts to reduce the dominant fixed cost are recommended to maintain the sustainability of the system and benefit from the technical advantages offered by the robot.

Keywords: Colorectal surgery; Cumulative sum analysis; Learning curve; Robotic surgery.

Similar articles

See all similar articles

Cited by 16 PubMed Central articles

See all "Cited by" articles

References

    1. Lancet Oncol. 2009 Jan;10(1):44-52 - PubMed
    1. N Engl J Med. 2004 May 13;350(20):2050-9 - PubMed
    1. Ann Surg Oncol. 2009 Jun;16(6):1480-7 - PubMed
    1. Int J Surg. 2014;12(8):805-9 - PubMed
    1. Int J Clin Oncol. 2015 Aug;20(4):633-40 - PubMed

Publication types

LinkOut - more resources

Feedback